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

Silva, Lucas Oliveira J. e; Anderson, Jana L.; Bellolio, M. Fernanda; Campbell, Ronna L.; Myers, Lucas A.; Luke, Anuradha; Jeffery, Molly Moore

doi:10.1016/j.ajem.2018.10.029

Cited by 10 publications

(14 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Trauma is often the main cause of paediatric EMS use, but this is age-specific and more common in older paediatric patients, whereas younger patients are more likely to have respiratory disorders and seizures 17. Paediatric mental health is an increasingly prominent reason for EMS usage, with a US-based study identifying that this category had the largest absolute increase across a 10-year period 18…”

Section: Introductionmentioning

confidence: 99%

Paediatric frequent use of emergency medical services: a systematic review

et al. 2022

View full text Add to dashboard Cite

BackgroundFrequent use of emergency medical services (EMS) is recognised to be a global phenomenon, although paediatric frequent use is poorly understood. This systematic review aimed to understand how paediatric frequent use of EMS is currently defined, identify factors associated with paediatric frequent use of EMS and determine effectiveness of interventions for paediatric patients who frequently use EMS.MethodsFour electronic databases (Medline, CINAHL, Web of Science and PsycINFO) were searched to September 2022 for primary, peer-reviewed research studies published in English from January 2000. Studies were included that examined frequent use (>1 contact during study period) of EMS or other services with arrival via EMS. Paediatric patients were defined as <18 years of age or otherwise defined by study authors as paediatric/adolescent/children. Data were extracted using a structured proforma, and quality was assessed using the Standard Quality Assessment Criteria for Quantitative Studies but did not influence inclusion decisions. Data were presented using narrative synthesis.ResultsThe search resulted in 4172 unique references, with 12 papers included in the review from 7 countries. Four were EMS studies, and eight Emergency Department with arrival via EMS. All studies used retrospective designs, with no interventional studies identified. Paediatric frequent EMS users were more likely to use services for medical reasons rather than trauma, including respiratory complaints, mental health and seizures, but data on gender and ethnicity were inconclusive and silent on socioeconomic status. There was no consistency in definitions of either a paediatric patient or of frequent use.ConclusionThe broad range of reasons for frequent use suggests that a single intervention is unlikely to be effective at addressing the causes of frequent use. There is a need for further research to better identify the underlying reasons for frequent EMS use among paediatric patients and to develop interventions in this population.

show abstract

Section: Introductionmentioning

confidence: 99%

Paediatric frequent use of emergency medical services: a systematic review

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Suicide is the second-leading cause of death among youths ages 10-19 years, especially among those with PTSD (3,4). Youth visits to psychiatric emergency rooms (PERs) for suicidality are rising across the United States, especially among those with traumatic stress exposure and self-harm behavior (5)(6)(7)(8)(9)(10)(11)(12).…”

mentioning

confidence: 99%

Reminder-Focused Positive Psychiatry: Suicide Prevention Among Youths With Comorbid Posttraumatic Stress Disorder and Suicidality

Ahmadi

Pynoos

Leuchter

et al. 2022

APT

View full text Add to dashboard Cite

This study aimed to investigate the effect of brief reminder-focused positive psychiatry and suicide prevention (RFPP-S) on suicidal ideation, posttraumatic stress disorder (PTSD) symptoms, and clinical outcomes among youths with PTSD treated in psychiatric emergency rooms.Methods: This study included youths with PTSD and suicidality who received either RFPP-S (N550) or treatment as usual (N5150). The Columbia Suicide Severity Rating Scale (C-SSRS), Clinician-Administered PTSD Scale for children and adolescents, University of California, Los Angeles Trauma Reminder Inventory, Patient Health Questionnaire-9, Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment Scale, and positive psychiatry test batteries were administered at baseline, on day 2, and 1 week and 1 month after discharge.Results: On day 2, the RFPP-S group showed a greater reduction in PTSD symptoms (55%) and reactivity to trauma and loss reminders (80%) compared with the control group (10% for both) (p50.001). A significantly greater reduction in C-SSRS score for RFPP-S (80%), compared with treatment as usual (15%), was noted (p50.001), and RFPP-S showed more rapid stabilization (mean6SD52.060.5 days) and enhanced postdischarge follow-up (100%) compared with treatment as usual (5.062.0 days and 50%, respectively) (p,0.05). RFPP-S, but not treatment as usual, was associated with significant increases in well-being, flexible thinking, and coping skills (p,0.05). Hospital readmission due to suicidality 1 month after discharge was 0% for the RFPP-S group and 20% for the control group.Conclusions: RFPP-S was associated with reduced PTSD symptoms, enhanced coping skills while experiencing trauma reminders, adoption of safety skills, rapid stabilization of acute crises of PTSD with suicidality, adherence to post-emergency room visits and treatment, and favorable clinical outcomes.

show abstract

“…1 Similar findings have been demonstrated by other EMSs agencies in North America. [2][3][4] An additional study from Southwestern Pennsylvania showed that 6% of pediatric EMSs transports are for asthma. 5 Given that respiratory disease in pediatric patients is commonly encountered by EMSs, improving the prehospital care for these patients is a natural target for research and quality improvement efforts.…”

mentioning

confidence: 99%

Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States

et al. 2022

View full text Add to dashboard Cite

Objective: This study aimed to compare statewide emergency medical services protocols for the management of pediatric respiratory distress. Methods:We performed a descriptive study of emergency medical services protocols for the management of pediatric respiratory distress in the United States, excluding those without model or mandatory protocols. We compared medication recommendations for specific disease processes, including asthma, croup, epiglottitis, anaphylaxis, generalized respiratory distress, intubation, and drug assisted intubation.Results: Thirty-four state protocols were included. All had protocols to address the management of pediatric respiratory distress. There was high agreement in albuterol use for bronchospasm and epinephrine use in anaphylaxis. Epinephrine was recommended in all anaphylaxis protocols, 27 croup protocols (79%), and 3 epiglottitis protocols (9%). Six states (18%) called for albuterol in patients with generalized respiratory distress. Steroid recommendations and indications had variance among states; 26 states (76%) allowed steroid use in patients with asthma, 19 states (56%) recommended steroid use in anaphylaxis, and 11 (32%) recommended steroid use in croup protocols. The route for steroid administration also varied among protocols. Five states (15%) allowed continuous positive airway pressure application in pediatric patients, whereas endotracheal intubation and rapid sequence intubations had varying requirements as well as recommendations for use. Twelve (35%) listed impending or current respiratory failure as an indication, whereas other states had specific markers, such as Glasgow Coma Scale or oxygen saturation, as indications.Conclusions: All included states had specific recommendations for the management of pediatric respiratory distress. There was consistency in recommendations for albuterol use for wheezing and epinephrine use for anaphylaxis. However, there was wide variability in other uses for epinephrine, steroid administration, continuous positive airway pressure use, and specific treatments for croup and epiglottitis. The findings of this study provide a base for important future evidence-based protocol developments and changes in prehospital pediatric respiratory distress treatment.

show abstract

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

Cited by 10 publications

References 19 publications

Paediatric frequent use of emergency medical services: a systematic review

Paediatric frequent use of emergency medical services: a systematic review

Reminder-Focused Positive Psychiatry: Suicide Prevention Among Youths With Comorbid Posttraumatic Stress Disorder and Suicidality

Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States

Contact Info

Product

Resources

About