125 - Emergency Medical Services Implementation of the Pediatric Assessment Triangle: Real-World Data

Publication Number: 125.4703

Shelby K. Shelton, Children's Hospital of Orange County, Orange, CA, United States; Kellie Bacon, CHOC Children's Hospital of Orange County, Orange, CA, United States; Helen Lee, CHOC Children's Hospital of Orange County, Orange, CA, United States; Anahita Darabpour, CHOC Children's Hospital of Orange County, San Marcos, CA, United States; Zoe Ta-Perez, CHOC Children's Hospital of Orange County, Orange, CA, United States; Carolina Amaya, CHOC Children's Hospital of Orange County, Austin, TX, United States; Theodore heyming, CHOC Children's Hospital of Orange County, Orange, CA, United States

Background: Emergency Medical Services (EMS) responds to over one million calls involving children in the United States each year, but pediatric patients represent a relatively small percentage of total 9-1-1 activations. EMS providers often report a lack of training and experience with children, leading to discomfort and uncertainty regarding assessment and treatment. The Pediatric Assessment Triangle (PAT), a three-item scale that measures appearance, breathing, and circulation in children, was designed to provide a rapid and standardized method of assessment that can be completed based solely on visual and auditory observation.

Objective: To investigate the use of PAT in the prehospital setting, specifically if it accurately predicts acuity in the ED.

Design/Methods: We completed a retrospective analysis of all EMS transports to a pediatric emergency department (ED) at a free-standing children’s hospital in the US. Data were queried from the EMS electronic health record and merged with hospital data. Only EMS runs with all three PAT variables were included in this analysis. Descriptive statistics and Chi-square tests were used to describe the cohort. This study was approved by the site’s IRB (#230227).

Results: We reviewed 2951 EMS runs from 11/2020-11/2023. Of these, 1951 (66.1%) patients were normal for all three variables, 517 (17.5%) were abnormal for appearance only, 232 (7.9%) for breathing only, and 37 (1.3%) for circulation only; 163 (5.5%) were abnormal for appearance and breathing; 97 (3.3%) for appearance and circulation; and 72 (2.4%) for breathing and circulation. 54 (1.8%) were abnormal for all three variables. Patients with two or three abnormal PAT variables were more likely to have airway management prehospital (p < 0.001), have CPR (p < 0.001), and receive either IV or IO access (p < 0.001). Patients with two or three abnormal variables were more likely to have a lower ESI score in the ED (p < 0.001) and be admitted to the ICU (p < 0.001). Patients with three abnormal PAT variables were more likely to have higher-order interventions, specifically CPR (p < 0.001), defibrillation (p < 0.001), chest tube (p < 0.001), intubation (p < 0.001), and central line placement (p < 0.001). Patients with no abnormal PAT variables were more likely to receive an orthopedic reduction (p < 0.001) and laceration repair (p < 0.001) in the ED.

Conclusion(s): We found that the PAT, as completed by EMS clinicians, can accurately predict higher acuity in the ED. This information can be used to support the use of PAT in the field and the need for communication of PAT to the receiving ED clinicians prior to patient arrival.