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Outcomes of paediatric patients who are not transported to hospital by Emergency Medical Services: a data linkage study
  1. Emily Nehme1,2,
  2. Ziad Nehme1,2,3,
  3. Shelley Cox1,2,
  4. Karen Smith2,3
  1. 1Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
  2. 2Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
  3. 3Department of Paramedicine, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Emily Nehme, Centre for Research and Evaluation, Ambulance Victoria, Doncaster VIC 3108, Victoria, Australia; emily.nehme{at}ambulance.vic.gov.au

Abstract

Background Data on the safety of non-transport decisions for paediatric patients attended by Emergency Medical Services (EMS) are lacking. We describe the characteristics and outcomes of paediatric non-transported patients in Victoria, Australia.

Methods A retrospective data linkage study of consecutive paediatric (aged <18 years) non-transported patients between January 2015 and June 2019. Patients were linked to ED, hospital admission and death records. Multivariable logistic regression analyses were used to determine factors associated with EMS recontact, ED presentation, hospital admission and an adverse event (death/cardiac arrest, intensive care unit admission or highest ED triage category) within 48 hours of the initial emergency call.

Results In total, 62 975 non-transported patients were included. The mean age was 7.1 (SD 6.0) years and 48.9% were male. Overall, 2.2% recontacted the EMS within 48 hours, 13.7% self-presented to a public ED, 2.4% were admitted to hospital and 0.1% had an adverse event, including two deaths. Among patients with paramedic-initiated non-transport (excluding transport refusals and transport via other means), 5.6% presented to a public ED, 1.1% were admitted to hospital and 0.05% had an adverse event. In the overall population, an abnormal vital sign on initial assessment increased the odds of hospital admission and an adverse event. Among paramedic-initiated non-transports, cases occurring in the early hours of the morning (04:00–08:00 hours) were associated with increased odds of subsequent hospital admission, while the odds of ED presentation and hospital admission also increased with increasing prior exposure to non-transported cases.

Conclusion Adverse events were rare among paramedic-initiated non-transport cases. Vital sign derangements and attendance by paramedics with higher prior exposure to non-transports were associated with poorer outcomes and may be used to improve safety.

  • pediatrics
  • emergency ambulance systems
  • pediatric emergency medicine
  • pre-hospital care

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Handling editor Caroline Leech

  • Twitter @Ziad_Nehme1

  • Contributors EN and KS conceived the study. EN and SC collected the data. EN conducted the literature search, statistical analyses and drafted the manuscript. All authors reviewed the manuscript and made critical revisions for intellectual property. EN acts as guarantor of the work.

  • Competing interests EN is supported by a National Health and Medical Research Council Postgraduate Scholarship (#2003449). ZN is supported by a Future Leader Fellowship (#105690) from the National Heart Foundation of Australia. All other authors report no conflicts of interest.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.