614 - EMS and ED Use Among US Children (2016–2022): A PECARN DGS–Based Analysis using the National Hospital Ambulatory Medical Care Survey (NHAMCS)

Publication Number: 1591.614

Jyotsna Sanjeevi, Beth Israel Deaconess Medical Center, Brighton, MA, United States; Jeanne-Marie Guise, Beth Israel Deaconess Medical Center, Boston, MA, United States; garth D. Meckler, University of British Columbia, Vancouver, BC, Canada

Background: Pediatric Emergency Care Applied Research Network (PECARN) developed a Diagnosis Grouping System (DGS), which groups ICD-10-CM codes into categories relevant to pediatric emergency care. The NHAMCS, which ended in 2022, is one of the few administrative databases capturing both ED data and EMS transports. Understanding EMS and ED use among pediatric patients, with this lens, can help identify pediatric ED and EMS needs, target resource allocation, and support emergency care across settings in a more clinically meaningful way specific to pediatrics.

Objective: To examine trends in pediatric emergency department and EMS utilization.

Design/Methods: We conducted a cross-sectional analysis of pediatric emergency department (PED) visits using NHAMCS data from 2016 to 2022. Diagnoses were categorized using the PECARN structure. Because many NHAMCS ICD-10 codes are recorded at the 3- or 4-digit level and were not directly classified in PECARN, we reviewed and assigned these parent codes to the most appropriate categories with clinician input. We summarize visit characteristics, acuity, and diagnostic distributions across groups.

Results: Over a seven-year time frame, there were 925 million ED visits, including 202 million pediatric visits (22%). PED visits fell at the height of the pandemic (2020) from an average of 30.85 to 21.23 million visits, returning to pre-pandemic volumes by 2022. Of all PED visits, 4.4% arrived by EMS; they were twice as likely to arrive by ambulance in urban compared to rural settings (4.75% vs 2.22%).

Using the PECARN-DGS, the most common diagnostic categories for PED visits were ENT/Dental & Mouth (19.0%), Gastrointestinal (14.6%), Systemic –e.g., fever, acute systemic states (13.3%), and Trauma (13.3%). Among those arriving by EMS, the leading categories: Trauma (22.0%), Neurologic (17.1%), and Psychiatric & Behavioral/ Substance Use (14.4%) accounted for over half of pediatric EMS transports; the latter of which is five times greater than the prevalence for overall PED visits (3.3%)

Conclusion(s): In this large representative sample of US ED visits, children comprise roughly ¼ of total visits. Less than 5% of PED visits arrive via EMS, but those arriving by ambulance are higher acuity and more likely to be admitted to hospital than those arriving by other means. What is perhaps most striking about these data is the high prevalence of psychiatric, behavioral, and substance use among children brought in by EMS, 14.4% vs 3.0% for all ED visits. This has significant implications for EMS training, support, and pediatric mental health crisis services.