Documentation of pediatric vital signs by EMS providers over time

Hewes, Hilary A; Hunsaker, Shari; Christensen, Mathew; Whitney, Jolene R.; Dalrymple, Tia; Taillac, Peter

doi:10.1016/j.jpedsurg.2015.10.001

Cited by 27 publications

(19 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The vital signs of children are different from those of adults [ 24 ]. Hewes et al reported that education for EMS providers improved the ratio of complete measurement of vital signs [ 15 ]. Educating continuously for EMS providers may promote to higher rate of measuring children’s vital signs in prehospital settings.…”

Section: Discussionmentioning

confidence: 99%

The association between age and vital signs documentation of trauma patients in prehospital settings: analysis of a nationwide database in Japan

et al. 2022

View full text Add to dashboard Cite

Background Emergency medical service (EMS) providers are the first medical professionals to make contact with patients in an emergency. However, the frequency of care by EMS providers for severely injured children is limited. Vital signs are important factors in assessing critically ill or injured patients in the prehospital setting. However, it has been reported that documentation of pediatric vital signs is sometimes omitted, and little is known regarding the performance rate of vital sign documentation by EMS providers in Japan. Using a nationwide data base in Japan, this study aimed to evaluate the relationship between patients’ age and the documentation of vital signs in prehospital settings. Methods This study was a secondary data analysis of the Japan Trauma Data Bank. The inclusion criterion was patients with severe trauma, as defined by an Injury Severity Score ≥ 16. Our primary outcome was the rate of recording all four basic vital signs, namely blood pressure, heart rate, respiratory rate, and level of consciousness in the prehospital setting among different age groups. We also compared the prehospital vital sign completion rate, that is, the rate at which all four vital signs were recorded in a prehospital setting based on age groups. Multivariate analysis was performed to evaluate factors associated with the prehospital vital sign completion rate. Results We analyzed 75,777 severely injured patients. Adults accounted for 94% (71400) of these severely injured patients, whereas only 6% of patients were children. The rate of prehospital recording of vital signs was lower in children ≤5 years than in adult patients for all four vital signs. When the adult group was used as a reference, the adjusted odds ratios of vital sign completion rate in infants (0 years), younger children (1–5 years), older children (6–11 years), and teenagers (12–17 years) were 0.09, 0.30, 0.78, and 0.87, respectively. Conclusions Analysis of the nationwide trauma registry showed that younger children tended to have a lower rate of vital sign documentation in prehospital settings.

show abstract

Section: Discussionmentioning

confidence: 99%

The association between age and vital signs documentation of trauma patients in prehospital settings: analysis of a nationwide database in Japan

et al. 2022

View full text Add to dashboard Cite

show abstract

“…However, previous studies have shown that VS are only moderate predictors when assessing children in need of a trauma centre [ 43 ] and, furthermore, that there is a correlation between the degree of acuity level and the number of VS that were registered [ 44 ]. Even though measuring VS in the EMS care of injured and sick children has been emphasised to reduce under-triage [ 45 , 46 ], implementing VS in all the patients in the MTS for paediatrics did not improve performance [ 47 ]. There are a number of reasons that may explain why not all VS according to the RETTS-p were measured in this study.…”

Section: Discussionmentioning

confidence: 99%

Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

Magnusson

Herlitz

Karlsson

et al. 2018

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

BackgroundThe assessment of children in the Emergency Medical Service (EMS) is infrequent representing 5.4% of the patients in an urban area in the western part of Sweden. In Sweden, patients are assessed on scene by an EMS nurse whom independently decides on interventions and level of care. To aid the EMS nurse in the assessment a triage instrument, Rapid Emergency Triage and Treatment System-paediatrics (RETTS-p) developed for Emergency Department (ED) purpose has been in use the last 5 years. The aim of this study was to evaluate the EMS nurse assessment, management, the utilisation of RETTS-p and patient outcome.MethodsA prospective, observational study was performed on 651 children aged < 16 years from January to December 2016. Statistical tests used in the study were Mann-Whitney U test, Fisher’s exact test and Spearman’s rank statistics.ResultsThe dispatch centre indexed life-threatening priority in 69% of the missions but, of all children, only 6.1% were given a life threatening RETTS-p red colour by the EMS nurse. A total of 69.7% of the children were transported to the ED and, of these, 31.7% were discharged without any interventions. Among the non-conveyed patients, 16 of 197 (8.1%) visited the ED within 72 h but only two were hospitalised. Full triage, including five out of five vital signs measurements and an emergency severity index, was conducted in 37.6% of all children. A triage colour was not present in 146 children (22.4%), of which the majority were non-conveyed. The overall 30-day mortality rate was 0.8% (n = 5) in children 0–15 years.ConclusionsDespite the incomplete use of all vital signs according to the RETTS-p, the EMS nurse assessment of children appears to be adapted to the clinical situation in most cases and the patients appear to be assessed to the appropriate level of care but indicating an over triage. It seems that the RETTS-p with full triage is used selectively in the pre-hospital assessment of children with a risk of death during the first 30 days of less than 1%.

show abstract

“…Thus, it is vital to encourage EMS providers to comprehensively examine the infant regardless of the possibly transient symptoms described by the caregivers. Indeed, even though EMS personnel did study vital signs more often than in the previously reported studies [13,24,33]; only heart rate, temperature and peripheral oxygen saturation reached over 50% coverage.…”

Section: Discussionmentioning

confidence: 75%

Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study

Oulasvirta

Harve‐Rytsälä

Lääperi

et al. 2021

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background The challenges encountered in emergency medical services (EMS) contacts with children are likely most pronounced in infants, but little is known about their out-of-hospital care. Our primary aim was to describe the characteristics of EMS contacts with infants. The secondary aims were to examine the symptom-based dispatch system for nonverbal infants, and to observe the association of unfavorable patient outcomes with patient and EMS mission characteristics. Methods In a population-based 5-year retrospective cohort of all 1712 EMS responses for infants (age < 1 year) in Helsinki, Finland (population 643,000, < 1-year old population 6548), we studied 1) the characteristics of EMS missions with infants; 2) mortality within 12 months; 3) pediatric intensive care unit (PICU) admissions; 4) medical state of the infant upon presentation to the emergency department (ED); 5) any medication or respiratory support given at the ED; 6) hospitalization; and 7) surgical procedures during the same hospital visit. Results 1712 infants with a median age of 6.7 months were encountered, comprising 0.4% of all EMS missions. The most common complaints were dyspnea, low-energy falls, and choking. Two infants died on-scene. The EMS transported 683 (39.9%) infants. One (0.1%) infant died during the 12-month follow-up period. Ninety-one infants had abnormal clinical examination upon arrival at the ED. PICU admissions (n = 28) were associated with young age (P < 0.01), a history of prematurity or problems in the neonatal period (P = 0.01), and previous EMS contacts within 72 h (P = 0.04). The adult-derived dispatch codes did not associate with the final diagnoses of the infants. Conclusions Infants form a small but distinct group in pediatric EMS care, with specific characteristics differing from the overall pediatric population. Many EMS contacts with infants were nonurgent or medically unjustified, possibly reflecting an unmet need for other family services. The use of adult-derived symptom codes for dispatching is not optimal for infants. Unfavorable patient outcomes were rare. Risk factors for such outcomes include quickly renewed contacts, young age and health problems in the neonatal period.

show abstract

Documentation of pediatric vital signs by EMS providers over time

Cited by 27 publications

References 4 publications

The association between age and vital signs documentation of trauma patients in prehospital settings: analysis of a nationwide database in Japan

The association between age and vital signs documentation of trauma patients in prehospital settings: analysis of a nationwide database in Japan

Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study

Contact Info

Product

Resources

About