Use of Emergency Medical Services for Children With Medical Complexity

OBJECTIVE: The care of children with medical complexity (CMC) in the prehospital setting is recognized as a priority in consensus-based Emergency Medical Services (EMS) guidelines. We examined EMS use, care patterns, and outcomes for CMC, including cardiac arrest and mortality. METHODS: We performed a multi-EMS agency and multicenter study of pediatric transports, from the scene to the hospital, to 1 of 17 hospitals within an integrated health system. We identified CMC based on encounter-level diagnosis and procedure codes. We described prehospital characteristics and identified which factors were associated with prehospital cardiac arrest and which factors were associated with in-hospital mortality. RESULTS: Of 68 890 pediatric encounters, 13 732 (19.9%) involved CMC, most commonly owing to neuromuscular conditions (29.7%). Among EMS encounters for CMC, 33.0% resulted in hospital admission, and 7.2% required critical care. Prehospital cardiac arrest occurred in 1.0% of cases, and in-hospital mortality was 0.7%. Among CMC, the presence of prehospital cardiac arrest was associated with cardiovascular (odds ratio [OR] 3.10, 95% CI: 2.08-4.62), neuromuscular (OR 2.71, 95% CI: 1.82-4.03), and neonatal (OR 2.71, 95% CI: 1.65-4.44) conditions. The presence of medical complexity was associated with a 9.55-times higher odds of in-hospital mortality (95% CI: 6.01-15.18). CONCLUSIONS: CMC account for one-fifth of EMS of pediatric encounters transported to the hospital. Our findings support targeted EMS training, technology-specific protocols, and integrated prehospital-hospital data systems to improve the safety and outcomes of CMC.