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Interhospital Transport of Critically Ill Children to PICUs in the United Kingdom and Republic of Ireland: Analysis of an International Dataset*

Ramnarayan, Padmanabhan, FRCPCH1; Dimitriades, Konstantinos, MPhil1; Freeburn, Lynsey, BScN2; Kashyap, Aravind, MMedSci3; Dixon, Michaela, PGDip4; Barry, Peter, W., PhD5; Claydon-Smith, Kathryn, BSc (Hons)6; Wardhaugh, Allan, MRCPCH7; Lamming, Caroline, R., RGN RHV8; Draper, Elizabeth, S., PhD8on behalf of the United Kingdom Paediatric Intensive Care Society Acute Transport Group

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6 - p e300–e311
doi: 10.1097/PCC.0000000000001506
Online Clinical Investigations

Objectives: International data on characteristics and outcomes of children transported from general hospitals to PICUs are scarce. We aimed to 1) describe the development of a common transport dataset in the United Kingdom and Ireland and 2) analyze transport data from a recent 2-year period.

Design: Retrospective analysis of prospectively collected data.

Setting: Specialist pediatric critical care transport teams and PICUs in the United Kingdom and Ireland.

Patients: Critically ill children less than 16 years old transported by pediatric critical care transport teams to PICUs in the United Kingdom and Ireland.

Interventions: None.

Measurements and Main Results: A common transport dataset was developed as part of the Paediatric Intensive Care Audit Network, and standardized data were collected from all PICUs and pediatric critical care transport teams from 2012. Anonymized data on transports (and linked PICU admissions) from a 2-year period (2014–2015) were analyzed to describe patient and transport characteristics, and in uni- and multivariate analyses, to study the association between key transport factors and PICU mortality. A total of 8,167 records were analyzed. Transported children were severely ill (median predicted mortality risk 4.4%) with around half being infants (4,226/8,167; 51.7%) and nearly half presenting with respiratory illnesses (3,619/8,167; 44.3%). The majority of transports were led by physicians (78.4%; consultants: 3,059/8,167, fellows: 3,344/8,167). The median time for a pediatric critical care transport team to arrive at the patient’s bedside from referral was 85 minutes (interquartile range, 58–135 min). Adverse events occurred in 369 transports (4.5%). There were considerable variations in how transports were organized and delivered across pediatric critical care transport teams. In multivariate analyses, consultant team leader and transport from an intensive care area were associated with PICU mortality (p = 0.006).

Conclusions: Variations exist in United Kingdom and Ireland services for critically ill children needing interhospital transport. Future studies should assess the impact of these variations on long-term patient outcomes taking into account treatment provided prior to transport.

1Children’s Acute Transport Service (CATS), Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.

2Northern Ireland Specialist Transfer and Retrieval Service (NISTAR), Belfast Health and Social Care Trust, Belfast, United Kingdom.

3North East Children’s Transport And Retrieval (NECTAR), Great North Children’s Hospital, Newcastle, United Kingdom.

4Wales & West Acute Transport for Children (WATCh), University Hospital of Bristol NHS Foundation Trust, Bristol, United Kingdom.

5Children’s Medical Emergency Transport (CoMET), University Hospitals of Leicester, Leicester, United Kingdom.

6North West and North Wales Transport Service, Central Manchester NHS Foundation Trust, Manchester, United Kingdom.

7Noah’s Ark Children’s Hospital for Wales, Cardiff and Vale University Health Board, Cardiff, United Kingdom.

8Paediatric Intensive Care Audit Network (PICANet), Department of Health Sciences, University of Leicester, Leicester, United Kingdom.

*See also p. 591.

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Dr. Draper’s institution received funding from Healthcare Quality Improvement Partnership. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies