Factors associated with EMS transport decisions for pediatric patients after motor vehicle collisions.

Objective: Prehospital non-transport events occur when emergency medicine service (EMS) providers respond to a scene, but the patient is ultimately not transported to a hospital for evaluation. The objective of this study was to determine the rate of non-transport of pediatric patients who were involved in a motor vehicle collision (MVC) and the factors associated with non-transport decisions.
Methods: We searched the National Emergency Medical Services Information System (NEMSIS) database using ICD-10 mechanism of injury codes to identify cases in which EMS responded to a pediatric occupant (age < 18 years) who had been involved in an MVC. We excluded interfacility transports, scene assists, deaths at the scene, and collisions that occurred outside the US. The outcome of interest was if pediatric patients were not transported to a hospital for evaluation. We performed univariate and multivariate analysis to identify which risk factors were associated with non-transport. We also analyzed regional variation and the reasons recorded for not transporting patients.
Results: We identified 92,254 pediatric patients who were evaluated by EMS after an MVC, of which 31,404 (34.0%) were not transported to a hospital for evaluation. In our adjusted analysis, the factors associated with non-transport were age <1 year or >16 years, male sex, normal Glasgow Coma Scale (GCS = 15), level of training of EMS providers, response time later than 6 a.m., and region of the country. GCS was the most important factor, with only 3.0% (108/3,616) of patients not transported who had abnormal GCS (< 15). In cases of non-transport, 32.7% (10257) were due to patient or caregiver refusal, and 33.3% (10,442) were due to patients being discharged against medical advice. Only 11.5% (3,627) pediatric patients who were not transported were discharged based on an established protocol.
Conclusions: Pediatric patients were not transported after EMS responded to an MVC in approximately one-third of cases, and there was considerable variation in the rate of non-transports based on geographic region, provider level, and time of day. The majority of non-transports occurred because patients were discharged against medical advice or the patient/caregiver refused transport, which may indicate conflicting priorities between EMS providers and patients.