P2.165: The Association of Patient and Emergency Medical Services Agency Factors with Quality of Pediatric Prehospital Care

Background: Pediatric prehospital care exists within a fragmented and heterogeneous system in the US and is of variable quality. EMS agencies differ in organizational structure, staffing models, and patient volumes. Little is known about whether these differences impact pediatric care quality. Our objective was to evaluate whether agency and demographic factors are associated with differences in performance on a set of national prehospital pediatric quality measures.

Methods: We performed a retrospective study using the 2020-2023 National EMS Information System (NEMSIS) datasets, including ground responses to a 9-1-1 dispatch for patients < 18 years old. We identified outcomes based on the NEMSIS Prehospital Pediatric Quality Measures Dashboard, including beta agonist for asthma/wheezing; glucagon/glucose for hypoglycemia; epinephrine for anaphylaxis; intravenous fluids for hypotension; pain assessment in trauma; pain improvement in trauma; and mental status, blood pressure, and respiratory rate documentation in trauma. Covariables were selected based on previous research evaluating quality of pediatric prehospital care. We evaluated the association of agency-level (level of service, pediatric volume, agency type, staffing status, tax status, urbanicity) and patient-level (age, race, sex, child opportunity index [COI]) factors with each outcome using multivariable mixed-effects logistic models with a random effect for EMS agency.

Results: We identified 4,625,478 pediatric EMS encounters (median age 10 years [IQR 3-15 years], 50.8% male). Median transport time was 14 minutes (IQR 9-21 minutes; Table 1). Data was missing for less than 1% of encounters for most variables, except for race (45.3% missing), transport time (39.7%), COI (34.7%) and urbanicity (2.7%). The proportion of cases achieving the performance measure ranged from 20.8% (improvement in pain for children with trauma reporting pain) to 85.3% (documentation of mental status, systolic blood pressure, and respiratory rate for children with trauma). Increasing age was associated with higher performance for five measures (adjusted odds ratios [aOR] range across the measures: 1.03-1.26). Female sex was associated with lower performance for five measures (aOR range 0.78-0.93). Black, Hispanic and Latino, and Asian children with trauma were less likely to have an improvement in pain compared to White children (aOR range 0.85-0.90). Advanced Life Support and Specialty Critical Care Units were associated with higher performance (aOR range 1.36-5.82 and 1.44-5.97, respectively), notwithstanding that most measures are within the scope of practice for Basic Life Support clinicians. EMS agency type, tax status, urbanicity, and the COI for the dispatch address were not consistently associated with quality of care (Table 2).

Conclusion: We identified several deficits in the quality of prehospital pediatric care. Patient demographic and EMS agency factors were associated with quality of care for some performance measures. Further research is needed to determine whether these differences are associated with patient outcomes and to develop strategies to reduce unwarranted variability in prehospital pediatric care.