title: How well do General EMS 911 dispatch protocols predict ED resource utilization for pediatric patients?
abstract: BACKGROUND
  The use of Emergency Medical Services (EMS) for low-acuity pediatric problems is well documented. Attempts have been made to curb potentially unnecessary transports, including using EMS dispatch protocols, shown to predict acuity and needs of adults. However, there are limited data about this in children. The primary objective of this study is to determine the pediatric emergency department (PED) resource utilization (surrogate of acuity level) for pediatric patients categorized as "low-acuity" by initial EMS protocols.
  
  
  METHODS
  Records of all pediatric patients classified as "low acuity" and transported to a PED in winter and summer of 2010 were reviewed. Details of the PED visit were recorded. Patients were categorized and compared based on chief complaint group. Resource utilization was defined as requiring any prescription medications, labs, procedures, consults, admission or transfer. "Under-triage" was defined as a "low-acuity" EMS transport subsequently requiring emergent interventions.
  
  
  RESULTS
  Of the 876 eligible cases, 801 were included; 392/801 had no resource utilization while 409 of 801 had resource utilization. Most (737/801) were discharged to home; however, 64/801 were admitted, including 1 of 801 requiring emergent intervention (under-triage rate 0.12%). Gastroenterology and trauma groups had a significant increase in resource utilization, while infectious disease and ear-nose-throat groups had decreased resource utilization.
  
  
  CONCLUSIONS
  While this EMS system did not well predict overall resource utilization, it safely identified most low-acuity patients, with a low under-triage rate. This study identifies subgroups of patients that could be managed without emergent transport and can be used to further refine current protocols or establish secondary triage systems.
authors.affiliation: Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. Electronic address: stephanie.fessler@pemaweb.com.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Fessler
authors.affiliation: Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA; Dept of Pediatrics, Emory University, Atlanta, GA, USA; Department of Emergency Medicine, Emory University.
authors.forename: Harold K
authors.initials: HK
authors.lastname: Simon
authors.affiliation: Grady Health Systems, Grady Emergency Medical Services, Atlanta, GA, USA; Department of Emergency Medicine, Emory University.
authors.forename: Arthur H
authors.initials: AH
authors.lastname: Yancey
authors.affiliation: Grady Health Systems, Grady Emergency Medical Services, Atlanta, GA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Colman
authors.affiliation: Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA; Dept of Pediatrics, Emory University, Atlanta, GA, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hirsh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D004631:Emergency Medical Service Communication Systems / Q000592:standards* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005845:Georgia; D006295:Health Resources / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000592:standards / Q000706:statistics & numerical data*; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014218:Triage / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D055815:Young Adult