Characteristics and outcomes of critically ill children transported by ambulance in a Turkish prehospital system: a multicenter prospective cohort study

Abstract

Background. The most underdeveloped area in the care of critically-ill-children (CIC) is the prehospital period. Appropriate prehospital assessment and life-saving-interventions (LSI) of this population are challenging and require dedicated resources to ensure the best outcomes. We aimed to determine the characteristics and outcomes of CIC transported to the Turkish Pediatric Emergency Departments (EDs). The frequency and distribution of LSI administered by prehospital providers on route and in the EDs were also investigated. Methods. This prospective study was conducted at 4 metropolitan cities and 9 tertiary pediatric EDs between August 2014-August 2015. A survey based study evaluated all CIC who were brought by ambulance to the participant EDs. CIC were defined as a patient who requires LSI or needs intensive care admission for any reason. Patient demographics, clinical features, reason for transport, performed procedures in the ambulance or ED were sought. Finally, the short-term outcomes of transported CIC and transport-associated risks were analyzed. Results. During the study period, a total 2094 children were brought by ambulance to all participant EDs. Only 227 (10.8%) of them were critically-ill. Emergency Medical Services (EMS) providers were less likely to perform procedures in CIC if they were staffed with paramedics (p<0.001). Most procedures were performed on children aged one or older (p<0.001). No procedure was performed in the ambulance for nearly one fourth of patients who received LSI in the EDs. If the EMS did not have a physician, prehospital providers were less likely to provide immediate LSIs (p<0.001). CIC were more likely referred from secondary/tertiary care hospitals. The short-term mortality rate was higher if the ambulance was staffed by only paramedics. Conclusion. This study demonstrated that Turkish prehospital pediatric emergency care is deficient. We offer a clinical overview of pediatric emergencies to aid EMS directors, policymakers, and ED directors in planning the care of CIC.

Morphometric analysis of middle and posterior cranial fossae foramina in 3D reconstructions of CT images: A midline asymmetry evaluation

“…In this study, the rate of patients admitted to pediatric ED by 112 ambulances was found as 1.3% annually.This rate was 5% and 7% in two different hospitals in the USA [6]. In a multicenter study from 9 hospitals in Turkey, it was reported that total number of children arriving to a pediatric ED by an ambulance was 2094 [7]. In our study, 3883 visits to a single center within a year indicated the workload of Kayseri City Hospital in the medical environment of Turkey.…”

Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review

“… 62 Similarly, a study in Turkey reported a higher short-term mortality rate among pediatric emergencies if the ambulance was staffed by only paramedics. 65 …”

“…57,58,63 Only a minority of ambulances across LMICs were physicianstaffed or had Basic Life Support (BLS)-trained personnel. [64][65][66][67][68] A study conducted among cardiac emergency cases in Iran found a lower death rate when transported by EMS. 62 Similarly, a study in Turkey reported a higher short-term mortality rate among pediatric emergencies if the ambulance was staffed by only paramedics.…”

“…62 Similarly, a study in Turkey reported a higher short-term mortality rate among pediatric emergencies if the ambulance was staffed by only paramedics. 65 Overall, factors such as absence of dedicated vehicles, lack of equipment on ambulances, and lack of skilled personnel during transportation were major challenges for effective transport care during an emergency (Table 2 8,10,31, ).…”