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Am J Emerg Med. 2018 Oct 18. pii: S0735-6757(18)30843-X. doi: 10.1016/j.ajem.2018.10.029. [Epub ahead of print]

Pediatric emergency medical services in privately insured patients: A 10-year national claims analysis.

Author information

1
Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States of America; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Brazil.
2
Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States of America. Electronic address: Anderson.jana@mayo.edu.
3
Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States of America; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America.
4
Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States of America.
5
Mayo Clinic Medical Transport, Mayo Clinic, Rochester, MN, United States of America.
6
Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States of America; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America; OptumLabs, Cambridge, MA, United States of America.

Abstract

OBJECTIVE:

To characterize pediatric Emergency Medicine Service (EMS) transports to the Emergency Department (ED) using a national claims database.

METHODS:

We included children, 18 years and younger, transported by EMS to an ED, from 2007 to 2016 in the OptumLabs Data Warehouse. ICD-9 and ICD-10 diagnosis codes were used to categorize disease system involvement. Interventions performed were extracted using procedure codes. ED visit severity was measured by the Minnesota Algorithm.

RESULTS:

Over a 10-year period, 239,243 children were transported. Trauma was the most frequent diagnosis category for transport for children ≥5 years of age, 35.1% (age 6-13) and 32.7% (age 14-18). The most common diagnosis category in children <6 years of age was neurologic (29.3%), followed by respiratory (23.1%). Over 10 years, transports for mental disorders represented 15.3% in children age 14 to 18, and had the greatest absolute increase (rate difference + 10.4 per 10,000) across all diagnoses categories. Neurologic transports also significantly increased in children age 14 to 18 (rate difference + 6.9 per 10,000). Trauma rates decreased across all age groups and had its greatest reduction among children age 14 to 18 (rate difference - 6.8 per 10,000). Across all age groups, an intervention was performed in 15.6%. Most children (83.3%) were deemed to have ED care needed type of visit, and 15.8% of the transports resulted in a hospital admission.

CONCLUSION:

Trauma is the most frequent diagnosis for transport in children older than 5 years of age. Mental health and neurologic transports have markedly increased, while trauma transports have decreased. Most children arriving by ambulance were classified as requiring ED level of care. These changes might have significant implication for EMS personnel and policy makers.

KEYWORDS:

Emergency medical services; Emergency medicine; Epidemiology; Pediatrics; Prehospital care

PMID:
30361150
DOI:
10.1016/j.ajem.2018.10.029

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