title: Route less travelled? Ambulance use for children with high-acuity acute illness.
abstract: OBJECTIVE
  Ambulance transportation offers important supportive care and treatment en route to definitive treatment. However, children may be at risk of under-utilising ambulance transportation, where private vehicle is possible. This study aims to determine how many of the sickest children present to hospitals in Auckland via ambulance and whether certain population groups are lower users of ambulance services.
  
  
  METHODS
  Transportation, demographic and outcome data were collected and analysed for children presenting to Starship Children's Health (Starship) from 1 January to 31 December 2011), who were 'self referrals' to hospital, less than 15 years of age, and assigned triage category 1 and 2 on presentation.
  
  
  RESULTS
  There were 1047 presentations to Starship identified that met inclusion criteria. Of these, 256 of the 341 triage one presentations (75.1%) and 217 of the 706 triage two presentations (30.7%) were transported by ambulance.Ambulance use was higher among older children (P < 0.001). Severity of illness or injury, as estimated by admission rates (56.7% vs. 43.3%, P = 0.21) and length of hospital stay (median = 1 day, P = 0.92), did not differ significantly by mode of transportation. There was no observed relationship with gender, ethnicity or area deprivation index score.
  
  
  CONCLUSIONS
  A significant proportion of acutely unwell children presenting to hospital were not transported by ambulance, particularly those aged less than 1 year. This has the potential to result in worse health outcomes. There were no identified associations with patient demographics, and further research is required to better understand this problem and develop solutions.
authors.affiliation: Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: Timothy
authors.initials: T
authors.lastname: Hopgood
authors.forename: Michael
authors.initials: M
authors.lastname: Shepherd
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000208:Acute Disease; D000552:Ambulances / Q000706:statistics & numerical data; D003625:Data Collection; D004635:Emergency Medicine / Q000706:statistics & numerical data; D009520:New Zealand; D014218:Triage; D044465:White People / Q000706:statistics & numerical data; D000095188:Pacific Island People / Q000706:statistics & numerical data
keywords: New Zealand; ambulance; child; emergency medicine; triage