Urban and Rural Patterns in Emergent Pediatric Transfer: A Call for Regionalization

Horeczko, Timothy; Marcin, James P.; Kahn, Jeremy M.; Sapién, Robert

doi:10.1111/jrh.12051

Cited by 27 publications

(18 citation statements)

References 27 publications

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“…Newgard et al [21] reported that rural areas had longer transfer distances and higher transfer rates (3.2% vs. 2.7%). This finding was in contrast to the results of Horeczko et al [46], who had found that urban and rural emergency departments showed similar transfer rates.…”

Section: Resultscontrasting

confidence: 99%

Factors Impacting Patient Outcomes Associated with Use of Emergency Medical Services Operating in Urban Versus Rural Areas: A Systematic Review

Alanazy

Wark

Fraser

et al. 2019

IJERPH

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The goal of this systematic review was to examine the existing literature base regarding the factors impacting patient outcomes associated with use of emergency medical services (EMS) operating in urban versus rural areas. A specific subfocus on low and lower-middle-income countries was planned but acknowledged in advance as being potentially limited by a lack of available data. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed during the preparation of this systematic review. A comprehensive literature search of PubMed, EBSCO (Elton B. Stephens Company) host, Web of Science, ProQuest, Embase, and Scopus was conducted through May 2018. To appraise the quality of the included papers, the Critical Appraisal Skills Programme Checklists (CASP) were used. Thirty-one relevant and appropriate studies were identified; however, only one study from a low or lower-middle-income country was located. The research indicated that EMS in urban areas are more likely to have shorter prehospital times, response times, on-scene times, and transport times when compared to EMS operating in rural areas. Additionally, urban patients with out-of-hospital cardiac arrest or trauma were found to have higher survival rates than rural patients. EMS in urban areas were generally associated with improved performance measures in key areas and associated higher survival rates than those in rural areas. These findings indicate that reducing key differences between rural and urban settings is a key factor in improving trauma patient survival rates. More research in rural areas is required to better understand the factors which can predict these differences and underpin improvements. The lack of research in this area is particularly evident in low- and lower-middle-income countries.

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Section: Resultscontrasting

confidence: 99%

Factors Impacting Patient Outcomes Associated with Use of Emergency Medical Services Operating in Urban Versus Rural Areas: A Systematic Review

Alanazy

Wark

Fraser

et al. 2019

IJERPH

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“…14 Although inter-facility transfer is commonly used as an outcome measure, this factor is also under-studied in the pediatric population. 8,18,19 Over 45% of pediatric trauma patients with moderate to severe injuries (ISS>15) transported via non-EMS to an adult trauma center required inter-facility transfer; in contrast, those who used EMS to reach an adult trauma center were less likely to require subsequent inter-facility transfer. As previously discussed, this may be due to proximity or field triage guidelines used by the trained EMS personnel.…”

Section: Discussionmentioning

confidence: 99%

Emergency medical services (EMS) versus non-EMS transport among injured children in the United States

Corrado

Shi

Wheeler

et al. 2017

The American Journal of Emergency Medicine

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Objectives-This study aimed to assess the proportions of injured children transported to trauma centers by different transportation modes and evaluate the effect of transportation mode on interfacility transfer rates using the U.S. national trauma registry.Methods-We analyzed data from the 2007-2012 National Trauma Data Bank (NTDB) to study trends of EMS versus non-EMS transport. Multivariable logistic regression was used to evaluate the association between transport mode and inter-facility transfer.Results-There were 286,871 pediatric trauma patients in the 2007-2012 NTDB; 45.8% arrived by ground ambulance, 8.6% arrived by air ambulance, and 37.5% arrived by non-EMS. From 2007-2012, there was no significant change among each transportation mode. Moderate to severely injured patients (ISS>15) comprised 13.3% of arrivals by ground ambulance, 26.7% of arrivals by air ambulance, and 8.3% of arrivals by non-EMS; those who used EMS were significantly less likely to be transferred to another facility than patients who used non-EMS transport. Moderate and severe pediatric patients arriving by non-EMS to adult trauma centers were more often transferred than those arriving at mixed trauma centers (45.8% and 6.8%, respectively).Conclusions-Over one third of US pediatric trauma patients used non-EMS transport to arrive at trauma centers. Moderate to severely injured children benefit from EMS transport and

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“…1 Three years later key stakeholders formed a national coalition to improve pediatric readiness and published a set of guidelines to address the gaps described by the Institute of Medicine. [2][3][4][5][6] In 2013, this group administered the National Pediatric Readiness Project, a web-based survey measuring compliance with these guidelines. 7,8 This assessment was completed by 4149 hospitals, representing 24 million of the 25.5 million annual US pediatric emergency department (ED) visits.…”

mentioning

confidence: 99%

Differences in the Quality of Pediatric Resuscitative Care Across a Spectrum of Emergency Departments

et al. 2016

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The quality of pediatric resuscitative care delivered across the spectrum of emergency departments (EDs) in the United States is poorly described. In a recent study, more than 4000 EDs completed the Pediatric Readiness Survey (PRS); however, the correlation of PRS scores with the quality of simulated or real patient care has not been described. OBJECTIVE To measure and compare the quality of resuscitative care delivered to simulated pediatric patients across a spectrum of EDs and to examine the correlation of PRS scores with quality measures. DESIGN, SETTING, AND PARTICIPANTS This prospective multicenter cohort study evaluated 58 interprofessional teams in their native pediatric or general ED resuscitation bays caring for a series of 3 simulated critically ill patients (sepsis, seizure, and cardiac arrest). MAIN OUTCOMES AND MEASURES A composite quality score (CQS) was measured as the sum of 4 domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. Pediatric Readiness Survey scores and health care professional demographics were collected as independent data. Correlations were explored between CQS and individual domain scores with PRS. RESULTS Overall, 58 teams from 30 hospitals participated (8 pediatric EDs [PEDs], 22 general EDs [GEDs]). The mean CQS was 71 (95% CI, 68-75); PEDs had a higher mean CQS (82; 95% CI, 79-85) vs GEDs (66; 95% CI, 63-69) and outperformed GEDs in all domains. However, when using generalized estimating equations to estimate CQS controlling for clustering of the data, PED status did not explain a higher CQS (β = 4.28; 95% CI, −4.58 to 13.13) while the log of pediatric patient volume did explain a higher CQS (β = 9.57; 95% CI, 2.64-16.49). The correlation of CQS to PRS was moderate (r = 0.51; P < .001). The correlation was weak for cardiac arrest (r = 0.24; P = .07), weak for sepsis (ρ = 0.45; P < .001) and seizure (ρ = 0.43; P = .001), and strong for teamwork (ρ = 0.71; P < .001). CONCLUSIONS AND RELEVANCE This multicenter study noted significant differences in the quality of simulated pediatric resuscitative care across a spectrum of EDs. The CQS was higher in PEDs compared with GEDs. However, when controlling for pediatric patient volume and other variables in a multivariable model, PED status does not explain a higher CQS while pediatric patient volume does. The correlation of the PRS was moderate for simulation-based measures of quality.

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Urban and Rural Patterns in Emergent Pediatric Transfer: A Call for Regionalization

Cited by 27 publications

References 27 publications

Factors Impacting Patient Outcomes Associated with Use of Emergency Medical Services Operating in Urban Versus Rural Areas: A Systematic Review

Factors Impacting Patient Outcomes Associated with Use of Emergency Medical Services Operating in Urban Versus Rural Areas: A Systematic Review

Emergency medical services (EMS) versus non-EMS transport among injured children in the United States

Differences in the Quality of Pediatric Resuscitative Care Across a Spectrum of Emergency Departments

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