Skip to main content Accessibility help

A Cost-Effectiveness Analysis of Pediatric Intraosseous Infusion as a Prehospital Skill

  • Herbert G. Garrison (a1), Stephen M. Downs (a2), Robert A. McNutt (a3) and Thomas R. Griggs (a3)



To determine the clinical efficacy, patient volume, and program costs that justify pediatric intraosseous (IO) infusion as a routine skill for the treatment of patients with cardiac arrest in a prehospital system.


A decision analytic model was constructed to include patient outcomes and costs to society. Critical variables for the analysis were: 1) time to vascular access; 2) success of vascular access; 3) clinical efficacy (i.e., the percentage of lives saved by early vascular access); 4) number of patients requiring IO annually; and 5) the cost of an IO program. Program costs included training and equipment expenses. Sensitivity analysis, which repeatedly evaluates the model using different values for the critical variables, identified those values at which IO would be cost-effective.


With an estimated 80% success rate for IO access within five minutes, the cost-per-life-saved would be [US] $161,000. This cost-effectiveness ratio assumed annual program expenses of $2,000 and one patient per year needing IO. The cost-effectiveness ratio also required a clinical efficacy of 2% for vascular access. To prove that the clinical efficacy of vascular access is in fact 2%, epidemiologic studies would require a sample of nearly 9,000 patients.


This analysis suggests IO probably is cost-effective given a clinical efficacy above 2%. While the true efficacy may be below this value, clinical studies are unlikely to have sufficient size to prove it. Therefore, emergency medical services (EMS) medical directors must make the decision to utilize IO based on their own beliefs about its clinical efficacy. Further, it must be considered in the context of other prehospital programs which may be more cost-effective. Such analyses permit establishment of rational priorities to rank programs in prehospital systems.


Corresponding author

Herbert G. Garrison, MD, Robert Wood Johnson Clinical Scholars Program, Campus Box 7105, University of North Carolina, Chapel Hill, NC 27599-7105 USA


Hide All
Presented at the 7th Annual Scientific Assembly of the National Association of EMS Physicians, Orlando, Florida, June 1991.



Hide All
1. Glaeser, PW, Losek, JD, Nelson, DB, et al. : Pediatric intraosseous infusions: Impact on vascular access time. Am J Emerg Med 1988;6:330332.
2. Brunette, DD, Fischer, R: Intravascular access in pediatric cardiac arrest. Am J Emerg Med 1988;6:577579.
3. Rossetti, V, Thompson, BM, Aprahamian, C, et al. : Difficulty and delay in intravascular access in pediatric arrests. Ann Emerg Med 1984;13:406. Abstract.
4. Fiser, DH: Intraosseous infusion. N Eng J Med 1990;322:15791581.
5. Spivey, WH: Intraosseous infusions: Current concepts. J Emerg Med 1990;8:382. Abstract.
6. Kanter, RK, Zimmerman, JJ, Strauss, RH, et al. : Pediatric emergency intravenous access: Evaluation of a protocol. AJDC 1986:140:132134.
7. Iserson, KV, Criss, E: Intraosseous infusions: A usable technique. Am J Emerg Med 1986;4:540542.
8. Orlowski, JP, Porembka, DT, Gallagher, JM, et al. : Comparison study of intraosseous, central intravenous, and peripheral intravenous infusions of emergency drugs. AJDC 1990; 144:112117.
9. Rosetti, VA, Thompson, BM, Miller, J, et al. : Intraosseous infusion: An alternative route of pediatric intravascular access. Ann Emerg Med 1985;14:885888.
10. Smith, RJ, Keseg, DP, Manley, LK, et al. : Intraosseous infusions by prehospital personnel in critically ill pediatric patients. Ann Emerg Med 1988;17:491495.
11. Miner, WF, Cornell, HM, Bolte, RG, et al. : Prehospital use of intraosseous infusion by paramedics. Pediatric Emerg Care 1989;5:57.
12. Losek, JD, Hennes, H, Glaeser, P, et al. : Prehospital care of the pulseless, nonbreathing pediatric patient. Am J Emerg Med 1987:5:370374.
13. Stroup, CA: Intraosseous infusion: Prehospital use in the critically ill pediatric patient. JEMS 1987;12:3839.
14. Seigler, RS, Tecklenburg, FW, Shealy, R: Prehospital intraosseous infusion by emergency medical services personnel: A prospective study. Pediatrics 1989:84:173177.
15. Valenzuela, TD, Criss, EA, Spaite, D, et al. : Cost-effectiveness analysis of paramedic emergency medical services in the treatment of prehospital cardiopulmonary arrest. Ann Emerg Med 1990:19:14071411.
16. Lieu, TA, Fleisher, GR, Schwartz, JS: Cost-effectiveness of rapid latex agglutination testing and throat culture for streptococcal pharyngitis. Pediatrics 1990:85:246256.
17. Garrison, HG, Benson, NH, Whitley, TW, et al. : Paramedic skills and medications: Practice options utilized by local advanced life support medical directors. Prehospital and Disaster Medicine 1991;6:2934.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed