Abstract
Introduction: Certain adult conditions treated by paramedics, such as myocardial infarction or stroke, have better outcomes if transported to a specialty centre, bypassing local generalist facilities when necessary. Little evidence exists to inform guidelines to identify pediatric patients who would benefit from direct transport to a pediatric centre. This study describes the characteristics of children brought to community emergency departments (ED) who subsequently required transfer to pediatric specialty care.Methods: A retrospective observational cohort study was performed in a metropolitan area with one tertiary pediatric specialty centre and four community EDs. The patient care record database was queried for patients under 16 years old transported by paramedics to a community ED during a five-year period. Secondary transfer to the pediatric specialty centre within 24 hours was identified. The primary outcome was percentage of transfers to specialty care. Descriptive statistics were used to characterize the whole group as well as stratified by age category, chief complaint and Canadian Triage Acuity Scale (CTAS).Results: A total of 872 pediatric patients were transported to community EDs with 95 (10.9%) requiring secondary transfer to the pediatric specialty centre. CTAS 1 and 2 were associated with increased secondary transfer (p<0.001). There were also differences in transfer proportion by chief complaint. There was no association between age or gender and transfer to pediatric specialty care.Conclusions: This retrospective study shows an association between acuity and certain chief complaints and percentage of secondary transfer to pediatric specialty care.
Highlights
Certain adult conditions treated by paramedics, such as myocardial infarction or stroke, have better outcomes if transported to a specialty centre, bypassing local generalist facilities when necessary
Guidelines that enabled paramedics to identify patients with STelevation myocardial infarction, notify the cardiology team and transport the patient directly to the regional specialty centre led to a decreased mortality from 8.9% to 1.9% compared to transporting to the nearest hospital [1]
Children brought by paramedics to a community emergency department (ED) and subsequently transferred to a tertiary care pediatric hospital may benefit from direct transport from the scene to a pediatric specialty centre
Summary
Certain adult conditions treated by paramedics, such as myocardial infarction or stroke, have better outcomes if transported to a specialty centre, bypassing local generalist facilities when necessary. There is a paucity of evidence to inform clinical guidelines that would assist prehospital identification of those patients who would benefit most from direct transport to the pediatric centre instead of the nearest hospital. This knowledge gap has recently been identified as a priority study objective for pediatric prehospital research [2]. Children brought by paramedics to a community emergency department (ED) and subsequently transferred to a tertiary care pediatric hospital may benefit from direct transport from the scene to a pediatric specialty centre
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