The Turkish Journal of Pediatrics 2021 , Vol 63 , Num 1
Characteristics and outcomes of critically ill children transported by ambulance in a Turkish prehospital system: a multicenter prospective cohort study
Eylem Ulaş Saz 1 ,Caner Turan 1 ,Murat Anıl 2 ,Alkan Bal 2 ,Gamze Gökalp 2 ,Hayri Levent Yılmaz 3 ,Sinem Sarı Gökay 3 ,Tuğçe Çelik 3 ,Nilden Tuygun 4 ,Halise Akça 4 ,Deniz Tekin 5 ,Sinan Oğuz 5 ,Tanju Çelik 6 ,Özlem Tekşam 7 ,Ayşe Gültekingil Keser 7 ,Gülser Esen Besli 8 ,Murat Duman 9 ,Ali Yurtseven 1
1 Division of Pediatric Emergency, Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
2 Division of Pediatric Emergency, Department of Pediatrics,Tepecik Teaching and Research Hospital, İzmir, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
3 Division of Pediatric Emergency, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
4 Division of Pediatric Emergency, Department of Pediatrics, Dr Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital, Ankara, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
5 Division of Pediatric Emergency, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
6 Division of Pediatric Emergency, Department of Pediatrics, Dr.Behçet Uz Children’s Disease and Surgery Training and Research Hospital, İzmir, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
7 Division of Pediatric Emergency, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
8 Division of Pediatric Emergency, Department of Pediatrics, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbul, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
9 Division of Pediatric Emergency, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
DOI : 10.24953/turkjped.2021.01.007 Background. The most underdeveloped area in the care of critically-ill-children (CIC) is the prehospital period. Appropriate prehospital assessment and life-saving-interventions (LSI) of this population are challenging and require dedicated resources to ensure the best outcomes. We aimed to determine the characteristics and outcomes of CIC transported to the Turkish Pediatric Emergency Departments (EDs). The frequency and distribution of LSI administered by prehospital providers on route and in the EDs were also investigated.

Methods. This prospective study was conducted at 4 metropolitan cities and 9 tertiary pediatric EDs between August 2014-August 2015. A survey based study evaluated all CIC who were brought by ambulance to the participant EDs. CIC were defined as a patient who requires LSI or needs intensive care admission for any reason. Patient demographics, clinical features, reason for transport, performed procedures in the ambulance or ED were sought. Finally, the short-term outcomes of transported CIC and transport-associated risks were analyzed.

Results. During the study period, a total 2094 children were brought by ambulance to all participant EDs. Only 227 (10.8%) of them were critically-ill. Emergency Medical Services (EMS) providers were less likely to perform procedures in CIC if they were staffed with paramedics (p<0.001). Most procedures were performed on children aged one or older (p<0.001). No procedure was performed in the ambulance for nearly one fourth of patients who received LSI in the EDs. If the EMS did not have a physician, prehospital providers were less likely to provide immediate LSIs (p<0.001). CIC were more likely referred from secondary/tertiary care hospitals. The short-term mortality rate was higher if the ambulance was staffed by only paramedics.

Conclusion. This study demonstrated that Turkish prehospital pediatric emergency care is deficient. We offer a clinical overview of pediatric emergencies to aid EMS directors, policymakers, and ED directors in planning the care of CIC. Keywords : prehospital care, critically ill children, ambulance, emergency medical service, paramedic

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