Association of volume and prehospital paediatric care quality in emergency medical services: retrospective analysis of a national sample

BACKGROUND: Children represent fewer than 10% of emergency medical services (EMS) encounters in the USA. We evaluated whether agency-level paediatric volume is associated with the quality of prehospital care provided. METHODS: We conducted a retrospective analysis of 7104 agencies that contributed data consistently to the 2022-2023 National Emergency Medical Services Information System database, including children (<18 years) from an out-of-hospital EMS encounter. We assessed outcomes based on adherence to paediatric-specific quality benchmarks using mixed-effects models. RESULTS: We identified 3 403 925 paediatric encounters (median age 10 years; IQR 3-15). The annual paediatric volumes serviced by the study agencies per year ranged from 0.5 to 62 443. Six measures had a positive association with EMS volume, one measure had a negative association with EMS volume and four measures had no association with EMS volume. Higher volumes were associated with beta agonist administration for asthma/wheeze (adjusted OR (aOR) 1.08 per twofold increase in volume, 95% CI 1.06 to 1.11), epinephrine for anaphylaxis (aOR 1.09, 95% CI 1.05 to 1.08), vital signs assessment in trauma (aOR 1.05, 95% CI 1.04 to 1.07), benzodiazepines for status epilepticus (aOR 1.21, 95% CI 1.17 to 1.25), oxygen or positive pressure ventilation for hypoxia (aOR 1.06, 95% CI 1.04 to 1.09) and naloxone for opioid overdose (aOR 1.08, 95% CI 1.02 to 1.14). Higher paediatric volume was negatively associated with improvement of pain status in trauma (aOR 0.96, 95% CI 0.95 to 0.97). Paediatric volume was not associated with management of hypoglycaemia (aOR 1.01, 95% CI 0.97 to 1.06) or hypotension (aOR 0.98, 95% CI 0.92 to 1.04), or analgesia (0.99, 95% CI 0.97 to 1.01) and pain assessment (aOR 1.01, 95% CI 0.99 to 1.04) in trauma. CONCLUSION: Higher paediatric volume EMS agencies had better adherence to some paediatric care quality measures but showed no association or an inverse association with others. Efforts to improve prehospital paediatric care quality should pay special attention to low-volume agencies.