title: Prehospital transport practices prevalent among patients presenting to the pediatric emergency of a tertiary care hospital.
abstract: OBJECTIVE
  Prehospital transport practices prevalent among children presenting to the emergency are under-reported. Our objectives were to evaluate the prehospital transport practices prevalent among children presenting to the pediatric emergency and their subsequent clinical course and outcome.
  
  
  METHODS
  In this prospective observational study we enrolled all children ≤17 years of age presenting to the pediatric emergency (from January to June 2013) and recorded their demographic data and variables pertaining to prehospital transport practices. Data was entered into Microsoft Excel and analyzed using Stata 11 (StataCorp, College Station, TX, USA).
  
  
  RESULTS
  A total of 319 patients presented to the emergency during the study period. Acute gastroenteritis, respiratory tract infection and fever were the most common reasons for presentation to the emergency. Seventy-three (23%) children required admission. Most commonly used public transport was auto-rickshaw (138, 43.5%) and median time taken to reach hospital was 22 min (interquartile range: 5, 720). Twenty-six patients were referred from another health facility. Of these, 25 were transported in ambulance unaccompanied. About 8% (25) of parents reported having difficulties in transporting their child to the hospital and 57% (181) of parents felt fellow passengers and drivers were unhelpful. On post-hoc analysis, only time taken to reach the hospital (30 vs. 20 min; relative risk [95% confidence interval]: 1.02 [1.007, 1.03], P = 0.003) and the illness nature were significant (45% vs. 2.6%; 0.58 [0.50, 0.67], P ≤ 0.0001) on multivariate analysis.
  
  
  CONCLUSIONS
  In relation to prehospital transport among pediatric patients we observed that one-quarter of children presenting to the emergency required admission, the auto-rickshaw was the commonest mode of transport and that there is a lack of prior communication before referring patients for further management.
authors: Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors: Jhuma
authors: J
authors: Sankar
authors: Department of Paediatrics, PGIMER, Dr. RML Hospital, New Delhi, India.
authors: Archana
authors: A
authors: Singh
authors: Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors: Praveen
authors: P
authors: Narsaria
authors: Department of Medicine, PGIMER, Dr. RML Hospital, New Delhi, India.
authors: Nishanth
authors: N
authors: Dev
authors: Department of Paediatrics, PGIMER, Dr. RML Hospital, New Delhi, India.
authors: Pradeep
authors: P
authors: Singh
authors: Department of Paediatrics, PGIMER, Dr. RML Hospital, New Delhi, India.
authors: Nandkishore
authors: N
authors: Dubey
keywords: Auto-rickshaw; delay in transport; inter-hospital transport; mode of transport; pediatric emergency; septic shock; transport