Emergency Medicine

Researchers examine use of emergency medical services and hospitalization for children with special needs

Based on a review of hospital charts, an estimated 2-24 percent of children in Utah who used emergency medical services (EMS) in 1991-1992 were children with special health care needs (CSHCN). Compared to other children in the State who used EMS, these children (who often have congenital anomalies or birth-related conditions) were more likely to be admitted to the hospital and to have longer stays and greater hospital charges than other children. They also were more likely than other children to use EMS for transfer between health care facilities and to receive prehospital procedures such as intravenous therapy.

EMS personnel required more time for CSHCN than other children at the scene. This suggested a need for an educational program for EMS providers concerning CSHCN, which was established within the Bureau of EMS, Utah Department of Health, in the period following the study. The University of Utah School of Medicine researchers who conducted the study call for a definition of CSHCN that can be applied to existing data to facilitate research on EMS and other medical care provided to these children. Their research was supported by the Agency for Healthcare Research and Quality (HS09057).

Led by Anthony Suruda, M.D., M.P.H., the researchers identified patterns of EMS usage for children (ages 0-17 years) by linking hospital record diagnosis information to the EMS run information in 1991 and 1992. They used three ICD-9-based definitions to identify CSHCN as:

1. Children with congenital anomalies and birth-related conditions.
2. those with diagnosis codes indicating a need for separate Medicaid reimbursement.
3. Children who met an operational surveillance definition of CSHCN from the Arizona Emergency Medicine Research Center, which consisted of 382 diagnosis and procedure codes used in a Tucson study of children with special needs.

More details are in "Usage of emergency medical services by children with special health care needs," by Dr. Suruda, Donald D. Vernon, M.D., Edma Diller, M.P.H., and J. Michael Dean, M.D., M.B.A., in the April 2000 Prehospital Emergency Care 4(2), pp. 131-135.

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