title: Appropriateness of ambulance transportation to a suburban pediatric emergency department.
abstract: OBJECTIVE
  To assess the appropriateness of ambulance use in patients presenting to a pediatric emergency department (ED), with regard to both medical necessity and insurance status.
  
  
  METHODS
  The authors conducted a one-year retrospective chart analysis of all patients (age range 2 weeks to 19 years) who were transported via ambulance in 1994 to a suburban children's hospital ED. ED records of all patients who arrived by ambulance were abstracted for demographic data, type of insurance, chief complaint, medical interventions, discharge diagnosis, and disposition. Ambulance transportation was deemed unnecessary unless the medical record revealed any of the following criteria: 1) requiring cardiopulmonary resuscitation, 2) respiratory distress, 3) altered mental status or seizure, 4) immobilization, 5) inability to walk, 6) admission to intensive care, 7) ambulance recommended by medical personnel, 8) motor vehicle collision, or 9) parents not on scene.
  
  
  RESULTS
  43% of the ambulance patients were insured by Medicaid, compared with 29% of the overall ED population. Thus, Medicaid patients were significantly more likely to use ambulance transportation than were patients with commercial insurance (p<0.001). 28% of patients who arrived by ambulance were judged to have used the ambulance transportation unnecessarily. Of the unnecessary transports, 60% were insured by Medicaid. Thus, Medicaid patients were significantly more likely to have used ambulance transportation unnecessarily (p<0.001). The most common reason for appropriate ambulance use was seizure activity; the most common reason for inappropriate use was fever.
  
  
  CONCLUSIONS
  Inappropriate use of ambulance transportation is common in this pediatric population, with Medicaid patients accounting for a significant majority of the misuse.
authors.affiliation: A.I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, Delaware 19899, USA. skost@nemours.org
authors.forename: S
authors.initials: S
authors.lastname: Kost
authors.forename: J
authors.initials: J
authors.lastname: Arruda
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D010372:Pediatrics; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000191:economics* / Q000592:standards*; D014481:United States