Date of Award

January 2025

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Linda Degutis

Abstract

Background/Purpose:Emergency Medical Services (EMS) is a valuable resource for evaluating, treating, and coordinating care for individuals who have sustained a traumatic brain injury (TBI). Among adults with a TBI, there is frequent refusal of EMS transport. This raises a public health concern because it can put a burden on resource utilization and reveal misperceptions regarding risk following head injuries. Less is known about whether similar patterns of non-transport exist among children with TBIs. The purpose of this study is to describe the epidemiology of pediatric head injuries attended by EMS and to identify factors associated with non-transport for these patients. Methods: We used the 2022 National Emergency Medical Services Information (NEMSIS) data and included patients ages 2-17 years. Our primary outcome was whether the incident resulted in transport or non-transport. We calculated descriptive statistics for patient and incident characteristics, stratified by transport status, and used Chi-square or Wilcoxon rank-sum tests to calculate differences between groups. We conducted simple and multivariable logistic regressions to generate odds ratios and 95% confidence intervals to identify factors associated with non-transport. Results: In 2022, 34.2% of 136,218 encounters in our cohort resulted in non-transport. The majority of all TBI patients were male, ages 12-17, White, had a GCS score of 15, and had a low initial acuity. Nearly half of all incidents happened between 12 and 9 PM, and most encounters were in an urban setting. The most common locations of incidents were roadside and residential, with more encounters resulting in non-transport happening at a residential location and more encounters resulting in transport happening at the roadside. ALS attended 82.7% of incidents resulting in non-transport and 77.1% of incidents resulting in transport. In the multivariable analyses, non-transport was less likely among children ages 12-17 (OR: 0.79, 95%CI: 0.75-0.83) compared to children ages 2-5. Non-transport was less likely among children with GCS<15 compared to GCS of 15 (OR: 0.11, 95%CI: 0.10-0.13) and among children with an emergent or critical initial acuity compared to low (Emergent OR: 0.28, 95%CI 0.27-0.30; Critical OR: 0.19, 95%CI 0.16-0.23). Similarly, odds of non-transport were lower among incidents happening in suburban or rural settings compared to urban settings. Incidents resulting in non-transport were more likely to be attended by ALS compared to BLS (OR: 2.11; 95% CI: 2.01-2.23). Conclusions: There are significant patient and incident-level factors associated with the decision to not transport children who have sustained a TBI, with urbanicity, GCS, and provider-documented initial acuity being strong predictors of non-transport. A better understanding of non-transport could inform patient care, decision-making, and have implications for healthcare utilization.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/16/2026

Download

Share

COinS