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Comparative Study
. 2018 Aug:199:200-205.e6.
doi: 10.1016/j.jpeds.2018.03.069. Epub 2018 May 11.

Differences in Prehospital Patient Assessments for Pediatric Versus Adult Patients

Sriram Ramgopal  1 , Jonathan Elmer  2 , Jeremiah Escajeda  3 , Christian Martin-Gill  3
Affiliations
Comparative Study

Differences in Prehospital Patient Assessments for Pediatric Versus Adult Patients

Sriram Ramgopal et al. J Pediatr. 2018 Aug.

Abstract

Objective: To evaluate whether completion of vital signs assessments in pediatric transports by emergency medical services (EMS) differs by patient age.

Study design: We reviewed records by 20 agencies in a regional EMS system in Southwestern Pennsylvania between April 1, 2013 and December 31, 2016. We abstracted demographics, vital signs (systolic blood pressure, heart rate, respiratory rate), clinical, and transport characteristics. We categorized age as neonates (≤30 days), infants (1 month to <1 year), toddler (1 to <2 years), early childhood (2 to <6 years), middle childhood (6 to <12 years), adolescent (12 to <18 years), and adult (≥18 years). We used unadjusted and adjusted logistic regression to test if age group was associated with vital signs documentation, reporting of Glasgow Coma Scale and pain scale after trauma, and recording of oxygen saturation and breath sounds in respiratory complaints, using adults as the reference group.

Results: In total, 371 746 cases (21 883 pediatric, 5.9%) were included. In adjusted analysis, most pediatric categories had reduced odds of complete vitals documentation (percent, OR, 95% CI): neonates (49.6%, 0.02, 0.02-0.03), infants (68.2%, 0.04, 0.03-0.04), toddlers (78.1%, 0.07, 0.06-0.07), early childhood (87.4%, 0.13, 0.12-0.15), and middle childhood (95.3%, 0.54, 0.46-0.63). Pain score documentation was lower in children after trauma (OR 0.80, 95%CI 0.76-0.85), and oxygen saturation documentation was lower in children with respiratory complaints (OR 0.20, 95%CI 0.18-0.25).

Conclusions: Pediatric patients were at increased risk of lacking vital signs documentation during prehospital care. This represents a critical area for education and quality improvement.

Keywords: emergency medical services; prehospital medicine.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1.
Figure 1.
STROBE diagram illustrating patient inclusion.
Figure 2.
Figure 2.
Odds ratios with 95% confidence intervals of complete vital signs assessments by age group in unadjusted and adjusted models.
See this image and copyright information in PMC

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