Pediatric Conditions Requiring Interfacility Transport From Emergency Departments: A Statewide Study of Regionalization.

OBJECTIVES: Pediatric care is increasingly regionalized, increasing rates of interfacility transport (IFT). However, it is unknown what conditions most frequently require IFT. This study's objective was to identify high-frequency pediatric conditions requiring IFT. METHODS: This is a statewide retrospective observational study from 2010 to 2012 of pediatric patients (<18 years of age) who underwent IFT in Maryland. Patients were identified from the Health Care Utilization Project's database using probabilistic linkage. This study identified the 20 most common pediatric IFT conditions, and the conditions with the highest IFT rates. RESULTS: Probabilistic linkage was successful for 2254 records. The largest age category was 0 to 4 years (43%). The top 3 IFT conditions were asthma (13.5%), epilepsy (8.5%), and diabetes mellitus (6.6%). Diabetes mellitus had the highest IFT rate (24%), followed by appendicitis (15.5%) and internal obstruction (14.4%). CONCLUSIONS: Specific pediatric conditions commonly require IFT and had high IFT rates in this statewide study. In addition, the largest age group undergoing IFT was young children (0 to 4 years of age). This study provides specific detail regarding conditions and ages impacted by IFT, and emergency medical services should consider incorporating these findings into transport destination algorithms. In addition, public health stakeholders should address implications of the concentration of care for these common pediatric conditions and younger age groups.

Factors associated with injuries among preschool children in Egypt: demographic and health survey results, 2014.

BACKGROUND: Childhood injuries are a significant and growing global public health problem, often with high morbidity and, at times, mortality. A large proportion of injuries in preschool children occur in or around the home. We aimed to identify socioeconomic and demographic factors associated with preschool children injuries in Egypt. METHODS: Secondary data analysis were done for the Egyptian Demographic and Health Surveys (EDHS), 2014. Potential associated factors were measured from data on child welfare and questions on the prevalence of accidents and injuries of preschool children. These data were linked to the children demographic data, maternal age at marriage, working status of the mother, and questions on childcare arrangements. RESULTS: Out of the 634 injured children, 520 (83.4%) children required medical care for their injuries. The most common reported injury was an open wound 288 (45.5%), followed by fractures 237 (35.7%), burns 124 (19.7%), electrical shock 12 (1.9%) and other unknown types of injury 15 (2.4%). There was a positive correlation between injury and child's age, household wealth, mother's age at marriage, and unsupervised children or children left in the care of a minor. CONCLUSION: Leaving children unsupervised or in the presence of other young children is significantly associated with the occurrence of child injuries.

Access and Barriers to Take-Home Naloxone Use among Emergency Department Patients with Opioid Misuse in Baltimore, Maryland, USA.

BACKGROUND: The opioid epidemic has prompted the expansion of take-home naloxone (THN) distribution programs. The proportion of emergency department (ED) patients with opioid misuse who have access to a naloxone kit (NK) and barriers to using it are unclear. Objective: Characterizing the access and barrier to NK use among at-risk ED patients. Methods: We enrolled a convenience sample of ED patients with active opioid misuse from May 21-July 31, 2018. We administered a survey to collect patients' demographic data, substance use history, and access to and use of NK. The primary outcome was NK access (prior receipt of a kit or prescription); secondary outcomes were knowledge and use of NK, and barriers to obtaining and using it. Results: Of 165 respondents, 71.5% knew of THN programs and 57.6% (n = 95) had access to THN by either having received a NK (n = 90) or a prescription (n = 5); 34 respondents received both. Among 39 (23.6%) who received a naloxone prescription, 25 (64.1%) filled it. 60.0% (n = 99) reported knowing how to administer naloxone; lack of training was the primary reason (n = 63/66, 96.9%) for their unfamiliarity. Patients who presented after an opioid overdose (25.5%; n = 42) were less likely to have knowledge of THN programs (57.1% vs. 76.4%), and to have received a NK (35.7% vs. 61.0%). Conclusion: Awareness of THN programs was high among our cohort. But approximately 60% the respondents received a NK or knew how to use it. Despite efforts to expand THN access, gaps in knowledge, access, and use exist.

Resource Utilization in Non-Academic Emergency Departments with Advanced Practice Providers.

INTRODUCTION: Advanced practice providers (APP), including physicians' assistants and nurse practitioners, have been increasingly incorporated into emergency department (ED) staffing over the past decade. There is scant literature examining resource utilization and the cost benefit of having APPs in the ED. The objectives of this study were to compare resource utilization in EDs that use APPs in their staffing model with those that do not and to estimate costs associated with the utilized resources. METHODS: In this five-year retrospective secondary data analysis of the Emergency Department Benchmarking Alliance (EDBA), we compared resource utilization rates in EDs with and without APPs in non-academic EDs. Primary outcomes were hospital admission and use of computed tomography (CT), radiography, ultrasound, and magnetic resonance imaging (MRI). Costs were estimated using the 2014 physician fee schedule and inpatient payments from the Centers for Medicare and Medicaid Services. We measured outcomes as rates per 100 visits. Data were analyzed using a mixed linear model with repeated measures, adjusted for annual volume, patient acuity, and attending hours. We used the adjusted net difference to project utilization costs between the two groups per 1000 visits. RESULTS: Of the 1054 EDs included in this study, 79% employed APPs. Relative to EDs without APPs, EDs staffing APPs had higher resource utilization rates (use per 100 visits): 3.0 more admissions (95% confidence interval [CI], 2.0-4.1), 1.7 more CTs (95% CI, 0.2-3.1), 4.5 more radiographs (95% CI, 2.2-6.9), and 1.0 more ultrasound (95% CI, 0.3-1.7) but comparable MRI use 0.1 (95% CI, -0.2-0.3). Projected costs of these differences varied among the resource utilized. Compared to EDs without APPs, EDs with APPs were estimated to have 30.4 more admissions per 1000 visits, which could accrue $414,717 in utilization costs. CONCLUSION: EDs staffing APPs were associated with modest increases in resource utilization as measured by admissions and imaging studies.