title: Emergency Medical Services Utilization by Children.
abstract: OBJECTIVE
  The aim of this study was to compare demographic and clinical features of children (0-14 years old) who arrived at general emergency departments (EDs) by emergency medical services (EMS) to those who arrived by private vehicles and other means in a rural, 3-county region of northern California.
  
  
  METHODS
  We reviewed 507 ED records of children who arrived at EDs by EMS and those who arrived by other means in 2013. We also analyzed prehospital procedures performed on all children transported to an area hospital by EMS.
  
  
  RESULTS
  Children arriving by EMS were older (9.0 vs 6.0 years; P < 0.001), more ill (mean Severity Classification Score, 2.9 vs 2.4; P < 0.001), and had longer lengths of stay (3.6 vs 2.1 hours; P < 0.001) compared with children who were transported to the EDs by other means. Children transported by EMS received more subspecialty consultations (18.7% vs 6.9%; P < 0.05) and had more diagnostic testing, including laboratory testing (22.9% vs 10.6%; P < 0.001), radiography (39.7% vs 20.8%; P < 0.001), and computed tomography scans (16.8% vs 2.9%; P < 0.001). Children arriving by EMS were transferred more frequently (8.8% vs 1.6%; P < 0.001) and had higher mean Severity Classification Scores compared with children arriving by other transportation even after adjusting for age and sex (β = 0.48; 95% confidence interval, 0.35-0.61; P < 0.001). Older children received more prehospital procedures compared with younger children, and these were of greater complexity and a wider spectrum.
  
  
  CONCLUSIONS
  Children transported to rural EDs via EMS are more ill and use more medical resources compared with those who arrive to the ED by other means of transportation.
authors.affiliation: From the Departments of Pediatrics, University of California, Davis.
authors.forename: Parul
authors.initials: P
authors.lastname: Dayal
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance.
authors.forename: Timothy
authors.initials: T
authors.lastname: Horeczko
authors.affiliation: The North-Coast Emergency Medical Services Agency, Humboldt, CA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Wraa
authors.affiliation: The North-Coast Emergency Medical Services Agency, Humboldt, CA.
authors.forename: Larry
authors.initials: L
authors.lastname: Karsteadt
authors.affiliation: The North-Coast Emergency Medical Services Agency, Humboldt, CA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Chapman
authors.affiliation: The North-Coast Emergency Medical Services Agency, Humboldt, CA.
authors.forename: Louis
authors.initials: L
authors.lastname: Bruhnke
authors.affiliation: From the Departments of Pediatrics, University of California, Davis.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Litman
authors.affiliation: Emergency Medicine, University of California, Davis.
authors.forename: Timothy
authors.initials: T
authors.lastname: Ruttan
authors.affiliation: From the Departments of Pediatrics, University of California, Davis.|Emergency Medicine, University of California, Davis.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
authors.affiliation: From the Departments of Pediatrics, University of California, Davis.
authors.forename: James
authors.initials: J
authors.lastname: Marcin
mesh_terms: D000293:Adolescent; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data* / Q000639:trends; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D012423:Rural Health / Q000592:standards* / Q000639:trends; D012720:Severity of Illness Index; D013997:Time Factors