To characterize the demographics and clinical features of children brought to the pediatric emergency department (ED) by emergency medical services (EMS), and to evaluate the association between mode of arrival and clinical outcomes.

We conducted a retrospective cross-sectional study using the multicenter Pediatric Emergency Care Applied Research Network (PECARN) Registry to compare ED encounters among children arriving by EMS versus other means. We used logistic regression to assess associations between arrival mode and outcomes: in-hospital mortality, hospital admission or transfer, and admission >48 hours.

We analyzed 5,063,641 ED encounters, of which 368,187 (7.3%) involved children brought by EMS. The most common diagnoses for EMS arrivals were trauma (23.0%), respiratory disease (14.3%), and neurologic disease (11.4%), while non-EMS arrivals most often presented with trauma (16.3%), ENT/dental (15.2%), and gastrointestinal disease (13.3%). Among EMS patients, seizures (7.8%), psychiatric conditions (7.8%), and extremity fractures/dislocations (5.4%) were the most common diagnosis subgroups. EMS arrivals had higher rates of mortality (0.4% vs <0.1%), hospital admission (35.0% vs 11.2%), and secondary transfer (2.0% vs 0.7%), but fewer admissions lasting over 48 hours (44.2% vs 48.8%). In multivariable models, EMS arrival was associated with increased odds of mortality (OR 3.04, 95% CI 2.70–3.44), admission or transfer (OR 2.31, 95% CI 2.29–2.33), and >48-hour admission (OR 0.90, 95% CI 0.89–0.91).

Children brought to pediatric hospitals by EMS more frequently presented with higher acuity of illness and/or injury, as suggested by multiple clinical outcomes. These findings underscore the importance of targeted clinical strategies and resource planning for this higher-risk population.