Documentation of Weight in Pediatric 9-1-1 Responses with Administration of Weight-Based Medications

About this Research Project

Authors: Susan J. Burnett¹, Baruch Schwartz², Amy Eisenhauer^3, Sara Moore⁴, Macall Leslie Salewon⁵, Brian M. Clemency¹

¹Department of Emergency Medicine, University at Buffalo
²Touro College of Medicine
³EMS for Children, Division of State EMS, New York State Department of Health
⁴Cayuga Health Transport
⁵Clinical and Research Services, ImageTrend Inc.

Background

Determining a child’s weight is a critical first step in administering the appropriate dose of a medication in an emergency. The National EMS Quality Alliance (NEMSQA) patient safety process measure, “Pediatrics-03b,” calls for the documentation of weight in kilograms or a length-based weight estimate for pediatric patients who receive weight-based medications in the settings of 9-1-1 requests. To date, no publication has documented compliance with this measure at the national level. The goal of this study was to describe documentation of weight in pediatric 9-1-1 responses and factors associated with compliance for this quality measure.

Methods

• We used the ImageTrend Collaborate 2024 national dataset to analyze 9-1-1 responses for pediatric patients (<18 years of age) who received medication by EMS clinicians.
• Patients were excluded if they only received medications via topical or inhalation routes, consistent with the NEMSQA measure definition.
• Weight documentation was obtained from eExam01 and eExam02 NEMSIS fields. Differences in weight documentation compliance were assessed by patient demographics, as well as unit and scene characteristics.
• Furthermore, medication type and administration routes were examined.
• Statistical analyses included chi-square tests for comparing proportions and multivariable logistic regression for the binary outcome of weight documentation.

Results

• Overall, 57,378 responses met the inclusion criteria, and 41,963 (73.1%) had a documented weight.
• Weights were less likely to be documented in cases involving adolescent (age 13-17) patients (Odds Ratio [OR]: 0.84, 95% Confidence Interval [95% CI]: 0.80-0.89), patients described as Black (OR: 0.76, 95% CI: 0.72-0.79), or those with lower acuity (OR: 0.60, 95% CI: 0.56-0.65).
• Weights were more likely to be documented in cases managed by advanced life support units (OR: 1.89, 95% CI: 1.75-2.04) and in patients described as male (OR: 1.06, 95%: 1.03-1.10).

Conclusion

Three-quarters of all 9-1-1 responses that met the Pediatrics-03b case definition were compliant with the measure. Establishing a benchmark and understanding barriers to optimal implementation are critical to improving the care and documentation of pediatric patients by EMS clinicians. Future studies should evaluate the case definition for the measure to determine the best approach for assessing and improving care in this domain.