Abstract
Background: Children have differing utilization of emergency medical services (EMS) by socioeconomic status. We evaluated differences in prehospital care among children by the Child Opportunity Index (COI), the agreement between a child's COI at the scene and at home, and in-hospital outcomes for children by COI. Methods: We performed a retrospective study of pediatric (<18 years) scene encounters from approximately 2000 united states ems agencies from the 2021-2022 eso data collaborative. we evaluated socioeconomic status using the multi-dimensional coi v2.0 at the scene. we described ems interventions and in-hospital outcomes by coi categories using ordinal regression. we evaluated the agreement between the home and scene coi. results: data were available for 99.8 of pediatric scene runs with 936940 included ems responses. children from lower coi areas more frequently had a response occurring at home 62.9 in very low coi areas 47.1 in very high coi areas. children from higher coi areas were more frequently not transported to the hospital odds ratio or 0.87 95 confidence interval ci 0.86-0.87. children in lower coi areas had lower use of physical or 1.23 95 ci 1.13-1.33 and chemical or 1.41 95 ci 1.29-1.55 restraints for behavioral health problems. among injured children with elevated pain scores 7 analgesia was provided more frequently to children in higher coi areas or 1.73 95 ci 1.65-1.81. the proportion of children in cardiac arrest was lowest from higher coi areas. among 107114 encounters with in-hospital data the odds of hospitalization was higher among children from higher coi areas or 1.14 95 ci 1.11-1.18 and was lower for in-hospital mortality or 0.75 95 ci 0.65-0.85. home and scene coi had a strong agreement kendalls w=" 0.81)." conclusion: patterns of ems utilization among children with prehospital emergencies differ by coi. some measures such as for in-hospital mortality occurred more frequently among children transported from very low coi areas whereas others such as admission occurred more frequently among children from very high coi areas. these findings have implications in ems planning and in alternative out-of-hospital care models including in regional placement of ambulance stations.>
