The Kids Are All Right: A Multiyear Statewide Analysis of Pediatric Nontransport

Introduction: In the world of emergency medical services, refusals of care and/or transport are relatively common. For those aged 18 years or greater, it is his/her right to refuse treatment and/or transport. Minors, however, are not allowed this autonomous decision. In situations such as these, a responsible adult is charged with the choice to continue or stop medical care. 

Objective: This study explores differences in nontransport among pediatric age ranges. 

Methods: This retrospective study captured all 9-1-1 ambulance requests in the state of Virginia for the years 2009 through 2013. Pediatric patients were isolated and then classified into Infant (0–1 years), toddler (2–5 years), child (6–10 years), tween (11–12 years), teen (13–16 years), and pre-adult (>16 years). Multivariate logistic regressions with time-fixed effects were utilized. Control variables included patient sex, race, EMS organizational ownership type, and EMS employment structure (paid, volunteer, or mixed). 

Results: Of all 9-1-1 requests during this time period, 288,120 pediatric patients were analyzed. Overall, 19.9% of all pediatric calls resulted in a refusal, and 3.2% resulted in a determination of “no treatment required.” Compared to refusal and no-treatment rates in adults (11% and 1.7%, respectively), pediatric patients were more likely to have a refusal issued (OR 1.98, p<0.000) and were more likely to be classified as “no treatment required” (OR 2.06, p<0.000). Logistic regression analyses showed increased patient age was positively associated with patient refusal (OR 1.058, p<0.000) and negatively associated with “no treatment required” (OR 0.883, p<0.000). When analyzed by age group, infants were 33% less likely to have a refusal issued (OR 0.667, p<0.000), but three times more likely to be classified as “no treatment required” (OR 3.136, p<0.000). 

Conclusion: Younger patients were more likely to receive no treatment, while older pediatric patients were more likely to have a refusal issued. Several factors may be in play, but the “scared new parent” may account for the higher likelihood of no-treatment 9-1-1 calls, while older teenagers might be allowed a bit more autonomy and input regarding their medical care. Previous research also highlights that providers are generally uncomfortable with pediatric patients and may influence the decisions of guardians.