IntroductionEconomic hardship is a major threat to children’s health, implying that pediatric out-of-hospital cardiac arrest (pOHCA) might be promoted by lower incomes and child poverty. To target resources, it is helpful to identify geographical hotspots. Rhode Island is area-wise the smallest state in the United States of America. It has one million inhabitants and is comparable to many larger cities worldwide. We aimed to investigate possible associations of pOHCA with economic factors and the COVID-19 pandemic. We tried to identify high-risk areas and evaluated whether the COVID-19 pandemic had an influence on delays in prehospital care.MethodsWe analyzed all pOHCA cases (patients under 18 years of age) in Rhode Island between March 1st, 2018, and February 28th, 2022. We performed Poisson regression with pOHCA as dependent and economic risk factors (median household income and child poverty rate from the United States Census Bureau) as well as the COVID-19 pandemic as independent variables. Hotspots were identified utilizing Local Indicators of Spatial Association (LISA) statistics in ArcGIS Pro (Esri Corp., Redlands). We used linear regression to assess the association of EMS related times with economic risk factors and COVID-19.ResultsFifty-one cases met our inclusion criteria. Lower median household incomes (incidence-rate ratio (IRR) 0.99 per 1,000$ MHI; p=0.01) and higher child poverty rates (IRR 1.02 per percent; p=0.02) were significantly associated with higher numbers of ambulance calls due to pOHCA. The pandemic did not have a significant influence (IRR 0.9; p=0.7). LISA identified 12 census tracts as hotspots (p<0.01). The pandemic was not associated with delays in prehospital care.ConclusionLower median household income and higher child poverty rate are associated with higher numbers of pOHCA.

Background: Infectious diseases, including COVID-19, have a severe impact on child health globally. We investigated whether emergency medical service (EMS) calls are a bellwether for future COVID-19 caseloads. We elaborated on geographical hotspots and socioeconomic risk factors. Methods: All EMS calls for suspected infectious disease in the pediatric population (under 18 years of age) in Rhode Island between 1 March 2018 and 28 February 2022 were included in this quasi-experimental ecological study. The first of March 2020 was the beginning of the COVID-19 pandemic. We used the 2020 census tract and the most recent COVID-19 data. We investigated associations between pediatric EMS calls and positive COVID-19 tests with time series analysis and identified geographical clusters using local indicators of spatial association. Economic risk factors were examined using Poisson regression. Results: We included 980 pediatric ambulance calls. Calls during the omicron wave were significantly associated with increases in positive COVID-19 tests one week later (p < 0.001). Lower median household income (IRR 0.99, 95% CI [0.99, 0.99]; p < 0.001) and a higher child poverty rate (IRR 1.02, 95% CI [1.02, 1.02]; p < 0.001) were associated with increased EMS calls. Neighborhood hotspots changed over time. Conclusion: Ambulance calls might be a predictor for major surges of COVID-19 in children.