Emergency medical services system utilization over the last 10 years: what predicts transport of children?

Objective: The aim of this study was to determine the predictors of pediatric ambulance transport and evaluate changes in utilization over a 10-year period.

Methods: The National Health Ambulatory Medical Care Survey emergency department (ED) data for visits by children aged younger than 19 years from 2000 to 2009 were analyzed using logistic regression. Age, ethnicity, race, sex, triage level, time of arrival, injury/poisoning, insurance, disposition, critical patient status, metropolitan statistical area (MSA), region, and hospital type were used to predict the mode of arrival (ambulance or nonambulance). Significant variables were evaluated for trends over time.

Results: Representing 209 million ED visits, 60,761 records were analyzed. Ambulance transport was more likely among children who were aged 12 to 18 years (P < 0.05), black (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.06-1.38), evaluated for an injury/poisoning (OR, 3.03; 95% CI, 2.75-3.34), publicly insured (OR, 1.16; 95% CI, 1.03-1.31), living in an MSA (OR, 1.73; 95% CI, 1.34-2.23), living in the northeast (P < 0.05), and overnight arrivals (OR, 1.47; 95% CI, 1.26-1.7). They were more likely to have an urgency of less than 15 minutes (OR, 4.46; 95% CI, 3.56-5.59), require admission (OR, 2.82; 95% CI, 2.33-3.41), and considered critical (OR, 5.15; 95% CI, 3.43-7.73). There was no significant change in ambulance utilization in children; however, about half of critical patients and over 80% of those with a high triage level did not arrive by ambulance.

Conclusions: Ambulance transport to the ED is used more often by teens, blacks, publicly insured, overnight arrivals, and those living in an MSA or the northeast. It is concerning that many children triaged with a high urgency or requiring critical care did not arrive by ambulance.