Completeness of Pediatric Versus Adult Patient Assessment Documentation in the National Emergency Medical Services Information System

Cercone, Angelica; Ramgopal, Sriram; Martin‐Gill, Christian

doi:10.1080/10903127.2023.2178563

Cited by 4 publications

(2 citation statements)

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“…Individual vital sign assessments are subject to differences with measurement and equipment (e.g., cuff size for blood pressure or method of HR measurement using palpation, auscultation, or a monitor). Not all patients had all vital signs acquired, a finding that has been reported in previous work and may be associated with lower patient acuity, younger patient age, and lack of pediatric‐sized equipiment 26,27 . We were unable to evaluate the necessity for each intervention categorized as lifesaving for our analysis: prior work has suggested, for example, that EMS frequently undertreats children with bradycardia 28 .…”

Section: Limitationsmentioning

confidence: 93%

“…Not all patients had all vital signs acquired, a finding that has been reported in previous work and may be associated with lower patient acuity, younger patient age, and lack of pediatric-sized equipiment. 26,27 We were unable to evaluate the necessity for each intervention categorized as lifesaving for our analysis: prior work has suggested, for example, that EMS frequently undertreats children with bradycardia. 28 Christian Martin-Gill designed the study, contributed to data analysis, and reviewed and revised the manuscript for important intellectual content.…”

Section: M Itati O N Smentioning

confidence: 99%

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Establishing outcome‐driven vital signs ranges for children in the prehospital setting

Ramgopal,

Horvat,

Macy

et al. 2023

Academic Emergency Medicine

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Background:Vital signs are frequently used in pediatric prehospital assessments and guide protocol utilization. Common pediatric vital sign classification criteria identify >80% of children in the prehospital setting as having abnormal vital signs, though few receive lifesaving interventions. We sought to identify data‐driven thresholds for abnormal vital signs by evaluating their association with prehospital lifesaving interventions.Methods:We evaluated prehospital care records for children (<18 years) transported to the hospital during 2022 from a large, national repository of EMS patient encounters. Predictors of interest were heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP) and pulse oximetry. HR, RR, and SBP were converted to Z‐scores derived from age‐based distributional models. Our outcome was potentially lifesaving interventions, defined as performance of selected respiratory procedures, resuscitative interventions, or medication administrations. Using cut point analysis, we identified higher specificity (maximal specificity with a minimum of 25% sensitivity) and higher sensitivity (maximal sensitivity with a minimum of 25% specificity) ranges for each vital sign and evaluated measures of diagnostic accuracy.Results.We included 987,515 children (median age 10 years; IQR 2‐15 years). A lifesaving intervention occurred in 4.3% (2.1% with respiratory procedures, 1.2% with resuscitative interventions, and 2.0% with medication administration). HR, RR, and SBP demonstrated a U‐shaped association with lifesaving interventions. Specificities ranged from 84.1 to 93.7% for higher specificity criteria, with RR demonstrating the best performance (sensitivity 84.6%, specificity 27.0% Sensitives ranged from 62.3 to 84.4% for higher sensitivity criteria.Conclusions:Cut points for pediatric vital signs were associated with lifesaving interventions, and specific age‐adjusted ranges can identify children at higher‐ and lower‐risk for receipt of lifesaving intervention. These ranges may be combined with other objective measures to improve the assessment of children in the prehospital setting, assist in optimizing protocol utilization, improve transport decision‐making, and guide destination selection.

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Section: Limitationsmentioning

confidence: 93%