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A Descriptive Analysis of Pediatric Prehospital Refusal of Medical Assistance Within a Single Service Provider System.
Pediatr Emerg Care 2020; 36(1):26-30PE

Abstract

OBJECTIVES

Pediatric refusal of medical assistance (RMA) is a potentially high-risk event with implications for both individual patient outcomes and greater emergency medical services system efficiency. The purpose of this study was to describe characteristics of pediatric RMA calls and outcomes.

METHODS

Single emergency medical services agency retrospective study of calls between January 1, 2011, and December 31, 2015, for pediatric patients resulting in RMA was performed. Dispatch complaint-matched case-control group was generated from transported patients.

RESULTS

The percentage of pediatric calls that resulted in RMA was 12.7%, compared with 5% adult calls (P < 0.0001). The 3 most common RMA dispatch complaints were seizures, difficulty breathing, and traffic accidents. Furthermore, 65.1% pediatric RMA calls were emergently dispatched, compared with 56.4% of transported pediatric patients (P = 0.01). Medical control was contacted for 4.6% RMA calls. The average ± SD word count for RMA patient care narratives was 179 ± 99 words, compared with 164 ± 139 words for controls (P = 0.11). Documentation of risk-benefit discussion occurred in 28.6% RMA narratives. Outcome data were available for 83.8% RMA patients. The percentage of RMA patients with documented alternative plans who completed the alternative plan was 61.6%. Within 72 hours of RMA, 5.0% of calls with known outcome resulted in unexpected emergency department visit. No unexpected emergency department visits resulted in admission. Five percent of RMA patients were admitted; 1 patient was admitted to the intensive care unit. No emergent surgeries or deaths occurred during the study period.

CONCLUSIONS

Pediatric RMA is common within our study population, and two thirds involve emergent dispatch. Although outcomes are generally good, refusal documentation is sparse and medical control is seldom contacted. Multiple opportunities for systems improvement exist.

Authors+Show Affiliations

From the Department of Emergency Medicine.Mayo Clinic Medical Transport, Mayo Clinic, Rochester, MN.From the Department of Emergency Medicine. Mayo Clinic Medical Transport, Mayo Clinic, Rochester, MN.From the Department of Emergency Medicine.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31895200

Citation

Mix, Felicia M., et al. "A Descriptive Analysis of Pediatric Prehospital Refusal of Medical Assistance Within a Single Service Provider System." Pediatric Emergency Care, vol. 36, no. 1, 2020, pp. 26-30.
Mix FM, Myers LA, Luke A, et al. A Descriptive Analysis of Pediatric Prehospital Refusal of Medical Assistance Within a Single Service Provider System. Pediatr Emerg Care. 2020;36(1):26-30.
Mix, F. M., Myers, L. A., Luke, A., & Sztajnkrycer, M. D. (2020). A Descriptive Analysis of Pediatric Prehospital Refusal of Medical Assistance Within a Single Service Provider System. Pediatric Emergency Care, 36(1), pp. 26-30. doi:10.1097/PEC.0000000000002018.
Mix FM, et al. A Descriptive Analysis of Pediatric Prehospital Refusal of Medical Assistance Within a Single Service Provider System. Pediatr Emerg Care. 2020;36(1):26-30. PubMed PMID: 31895200.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Descriptive Analysis of Pediatric Prehospital Refusal of Medical Assistance Within a Single Service Provider System. AU - Mix,Felicia M, AU - Myers,Lucas A, AU - Luke,Anurahda, AU - Sztajnkrycer,Matthew D, PY - 2020/1/3/entrez SP - 26 EP - 30 JF - Pediatric emergency care JO - Pediatr Emerg Care VL - 36 IS - 1 N2 - OBJECTIVES: Pediatric refusal of medical assistance (RMA) is a potentially high-risk event with implications for both individual patient outcomes and greater emergency medical services system efficiency. The purpose of this study was to describe characteristics of pediatric RMA calls and outcomes. METHODS: Single emergency medical services agency retrospective study of calls between January 1, 2011, and December 31, 2015, for pediatric patients resulting in RMA was performed. Dispatch complaint-matched case-control group was generated from transported patients. RESULTS: The percentage of pediatric calls that resulted in RMA was 12.7%, compared with 5% adult calls (P < 0.0001). The 3 most common RMA dispatch complaints were seizures, difficulty breathing, and traffic accidents. Furthermore, 65.1% pediatric RMA calls were emergently dispatched, compared with 56.4% of transported pediatric patients (P = 0.01). Medical control was contacted for 4.6% RMA calls. The average ± SD word count for RMA patient care narratives was 179 ± 99 words, compared with 164 ± 139 words for controls (P = 0.11). Documentation of risk-benefit discussion occurred in 28.6% RMA narratives. Outcome data were available for 83.8% RMA patients. The percentage of RMA patients with documented alternative plans who completed the alternative plan was 61.6%. Within 72 hours of RMA, 5.0% of calls with known outcome resulted in unexpected emergency department visit. No unexpected emergency department visits resulted in admission. Five percent of RMA patients were admitted; 1 patient was admitted to the intensive care unit. No emergent surgeries or deaths occurred during the study period. CONCLUSIONS: Pediatric RMA is common within our study population, and two thirds involve emergent dispatch. Although outcomes are generally good, refusal documentation is sparse and medical control is seldom contacted. Multiple opportunities for systems improvement exist. SN - 1535-1815 UR - https://www.unboundmedicine.com/medline/citation/31895200/A_Descriptive_Analysis_of_Pediatric_Prehospital_Refusal_of_Medical_Assistance_Within_a_Single_Service_Provider_System L2 - http://dx.doi.org/10.1097/PEC.0000000000002018 DB - PRIME DP - Unbound Medicine ER -