title: Calling 911! What role does the pediatrician play?
abstract: OBJECTIVE
  The objective of this study was to compare admission rates and medical interventions among children whose caregivers called their child's primary care provider (PCP) before taking an ambulance to the pediatric emergency department (PED) versus those who did not.
  
  
  METHODS
  This was a prospective cohort study of patients brought to an urban, public hospital PED via emergency medical system (EMS). Children were included if the caregiver called 911 to have them transported via EMS and was present in the PED. The main variable was whether the child's PCP was called before EMS utilization. Study outcomes were medical interventions, such as intravenous line insertion or laboratory tests, and hospital admission. χ Test and logistic regression were used to evaluate the relationship of the main variable to the study outcomes.
  
  
  RESULTS
  Six hundred fourteen patients met inclusion criteria and were enrolled. Five hundred eighty-five patients (95.3%) were reported to have a PCP. Seventy-four caregivers (12.1%) called their child's PCP before calling EMS. Two hundred seventy-seven patients (45.1%) had medical interventions performed; of these, 42 (15.2%) called their PCP (P = 0.03). Forty-two patients (6.8%) were admitted; among these, 14 (33.3%) called their PCP (P < 0.01). Adjusting for triage level, patients whose caregiver called the PCP before calling EMS were 3.2 times (95% confidence interval, 1.9-5.2 times) more likely to be admitted and 1.7 times (95% confidence interval, 1.1-2.9 times) more likely to have a medical intervention compared with patients whose caregivers did not call their child's PCP.
  
  
  CONCLUSIONS
  Children were more likely to be admitted or require a medical intervention if their caregiver called their PCP before calling EMS. The availability of a PCP for telephone triage may help to optimize EMS utilization.
authors.affiliation: Lewis M. Fraad Department of Pediatrics (Emergency Medicine), Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. devin.grossman@stonybrookmedicine.edu
authors.forename: Devin
authors.initials: D
authors.lastname: Grossman
authors.forename: Sergey
authors.initials: S
authors.lastname: Kunkov
authors.forename: Carl
authors.initials: C
authors.lastname: Kaplan
authors.forename: Ellen F
authors.initials: EF
authors.lastname: Crain
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data; D001007:Anxiety; D017028:Caregivers / Q000523:psychology*; D002648:Child; D003953:Diagnosis-Related Groups; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control* / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009519:New York City; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010343:Patient Admission; D010372:Pediatrics / Q000458:organization & administration*; D010819:Physician's Role; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013689:Telephone; D014218:Triage; D055815:Young Adult