2123.0 - Predictors of non-transport for EMS incidents of pediatric head injuries

Program: Injury Control and Emergency Health Services

Session: Research Addressing Trauma Services, Emergency Medicine, and EMS Response Posters

Presenter: Margaret Zhang

Author: Linda Degutis

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Abstract

Background/Purpose

Emergency Medical Services (EMS) is a valuable resource for evaluating, treating, and coordinating care for individuals who have sustained a traumatic brain injury (TBI). Among adults who have sustained a TBI, there is frequent refusal of EMS transport. This raises a public health concern because it can put a burden on resource utilization and reveal misperceptions regarding risk following head injuries. Less is known about whether similar patterns of non-transport exist among children with TBIs. The purpose of this study is to describe the epidemiology of pediatric head injuries attended by EMS and to identify factors associated with non-transport for these patients.

Methods

We used the 2022 National Emergency Medical Services Information (NEMSIS) data and included patients ages 2-17 years. Individuals were classified as having a TBI if they had an ICD-10 code related to injuries to the skull and brain in the primary impression, secondary impression, primary symptom, or secondary symptom fields. We also included individuals who had both documented possible injury and head-related chief complaint.

Our primary outcome was whether the patient was transported or not, identified using eDisposition.12 (Incident/Patient Disposition). We calculated descriptive statistics for patient and incident characteristics, stratified by transport status, and used Chi-square or Wilcoxon rank-sum tests to calculate differences between groups. We conducted simple and multivariable logistic regressions to generate odds ratios and 95% confidence intervals to identify factors associated with non-transport.

Results

In 2022, 34.2% of 136,218 encounters in our cohort resulted in non-transport. The majority of all TBI patients were male, ages 12-17, White, had a GCS score of 15, and had a low initial acuity. Nearly half of all incidents happened between 12 and 9 PM, and most encounters were in an urban setting. The most common locations of encounters were roadside and residential, with more encounters resulting in non-transport happening at a residential location and more encounters resulting in transport happening at the roadside. ALS attended 82.7% of incidents resulting in non-transport and 77.1% of incidents resulting in transport.

In the multivariable analyses, non-transport was more likely among children ages 6-11 (OR: 1.06, 95%CI: 1.01-1.12) and less likely among children ages 12-17 (OR: 0.94, 95%CI: 0.90-0.98) compared to children ages 2-5. Non-transport was less likely among children with GCS<15 compared to GCS of 15 (OR: 0.11, 95%CI: 0.09-0.13) and among children with an emergent or critical initial acuity compared to low (emergent OR: 0.27, 95%CI 0.26-0.29; critical OR: 0.18, 95%CI 0.15-0.21). Similarly, odds of non-transport were lower among incidents happening in suburban or rural settings compared to urban settings. Incidents resulting in non-transport were more likely to be attended by ALS compared to BLS (OR: 1.95; 95% CI: 1.85-2.04).

Conclusions

There are significant patient and incident-level factors associated with the decision to not transport children who have sustained a TBI, with urbanicity, GCS, and provider-documented initial acuity being strong predictors of non-transport. A better understanding of non-transport could inform patient care, decision-making, and have implications for healthcare utilization, ultimately supporting the broader goal of improving population health outcomes.