Emergency Medicine

One in six emergency transports of children to South Carolina emergency rooms is medically unnecessary

One in every six children transported by emergency medical services (EMS) to hospital emergency departments (EDs) in three South Carolina counties is medically unnecessary, according to a new study. Children under 2 years of age had the highest proportion of medically unnecessary trips (26.6 percent), as did children in rural locales and Medicaid-insured children (who are less likely to receive routine or sick care or to have transportation). Based on information for all EMS-to-hospital transports of children in the three counties between January 1, 2001 and March 31, 2003, 16.4 percent of transports were deemed medically unnecessary.

The researchers classified all transports involving a car accident, death on arrival, and death during transport as medically necessary, as were EMS/paramedic codes of unconsciousness, cardiac and stroke-related conditions, respiratory distress, altered mental status, gastrointestinal problems, and genitourinary problems. Of the 1,714 diagnosis codes encountered in the ED data, 620 were classified as medically unnecessary, 334 as medically necessary, and 760 as uncertain (which were recoded as medically necessary to err conservatively).

The most common medically unnecessary conditions varied by age group. For children through age 4, upper respiratory problems and related conditions such as otitis media (bacterial infection of the middle ear) were among the most common diagnoses. For ages 5 to 12, no single diagnosis represented more than 10 percent of medically unnecessary transports.

However, possible viral conditions and upper respiratory problems were notable. From age 13 on, behavioral conditions, including drug use, depression, and conduct disorders were the most common diagnoses associated with a medically unnecessary transport.

The researchers suggest that interventions targeting unnecessary use of EMS transport should consider improving access to care by improving alternative and public modes of transportation. The study was supported by the Agency for Healthcare Research and Quality (T32 HS00032).

More details are in "Medically unnecessary emergency medical services (EMS) transports among children 0 to 17 years," by P. Daniel Patterson, Ph.D., Elizabeth G. Baxley, M.D., Janice C. Probst, Ph.D., and others, in Maternal and Child Health Journal 10, pp. 527-536, 2006.

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