Prognostic impact of complications during transport of critically ill children
DOI:
https://doi.org/10.15448/1980-6108.2020.1.34725Keywords:
patients’ transportation, prehospital care, pediatric intensive care unitAbstract
Aims: Transport of critically ill children involves particularities that increase the risk of complications. The objective was to investigate the impact of these complications recorded during transport on overall mortality and hospital discharge rate.
Method: Two-step study: the first was a cross-sectional study, in which, through standardized interviews with the doctor who admitted these children, potential complications during transport were identified. Three independent doctors audited this data. The second step was a prospective cohort, where patients divided into two groups (with and without transport complications) were followed prospectively.
Results: One hundred and forty-three children were included in the study. At least one complication during transport was observed in 74 of them (52%). The most frequent complication was related to monitoring and device failures (42%). The occurrence of transport complications was associated with higher hospital mortality (Hazard ratio (HR): 5.60; 95% confidence interval (95%CI: 1.26 - 26.65; p = 0.013) and the lowest
hospital discharge rate (HR: 0.48; 95%CI: 0.31 - 0.74; p = 0.0007). After Cox regression to adjust for confounding factors, the presence of complications remained associated with hospital mortality (HR: 6.74; 95%CI: 1.40 - 32.34; p = 0.017), but no remained associated with hospital discharge rate (HR: 0.76; 95%CI: 0.49 - 1.16; p = 0.213).
Conclusion: The presence of complications during pediatric transport was frequent in metropolitan region of
Ribeirão Preto, São Paulo, Brazil. The occurrence of complications was an independent predictor for hospital mortality.
Downloads
References
Henning R, McNamara V. Difficulties encountered in transport of the critically ill child. Pediatr Emerg Care. 1991;7(3):133-7. https://doi.org/10.1097/00006565-199106000-00001.
O’Dwyer G, Konder MT, Machado CV, Alves CP, Alves RP. The current scenario of emergency care policies in Brazil. BMC Health Serv Res. 2013;13:70. https://doi.org/10.1186/1472-6963-13-70.
Orr RA, Felmet KA, Han Y, McCloskey KA, Dragotta MA, Bills DM, et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics. 2009;124(1):40-8. https://doi.org/10.1542/peds.2008-0515.
Ramnarayan P, Polke E. The state of paediatric intensive care retrieval in Britain. Arch Dis Child. 2012;97(2):145-9. https://doi.org/10.1136/adc.2010.204503.
Ramnarayan P, Thiru K, Parslow RC, Harrison DA, Draper ES, Rowan KM. Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study. Lancet. 2010;376(9742):698- 704. https://doi.org/10.1016/S0140-6736(10)61113-0.
Edge WE, Kanter RK, Weigle CG, Walsh RF. Reduction of morbidity in interhospital transport by specialized pediatric staff. Crit Care Med. 1994;22(7):1186-91. https://doi.org/10.1097/00003246-199407000-00023.
Stroud MH, Prodhan P, Moss M, Fiser R, Schexnayder S, Anand K. Enhanced monitoring improves pediatric transport outcomes: a randomized controlled trial. Pediatrics. 2011;127(1):42-8. https://doi.org/10.1542/peds.2010-1336.
Moynihan K, McSharry B, Reed P, Buckley D. Impact of Retrieval, Distance Traveled, and Referral Center on Outcomes in Unplanned Admissions to a National PICU. Pediatr Crit Care Med. 2016;17(2):e34-42. https://doi.org/10.1097/PCC.0000000000000586.
Bigelow AM, Gothard MD, Schwartz HP, Bigham MT. Intubation in Pediatric/Neonatal Critical Care Transport: National Performance. Prehosp Emerg Care. 2015;19(3):351-7. https://doi.org/10.3109/10903127.2014.980481.
Vos GD, Nieman FH, Meurs AM, Van Waardenburg DA, Ramsay G, Donckerwolcke RA. Problems in interhospital pediatric intensive care transport in The Netherlands: results from a survey of general pediatricians. Intensive Care Med. 2003;29(9):1555-9. https://doi.org/10.1007/s00134-003-1889-6.
Durairaj L, Will JG, Torner JC, Doebbeling BN. Prognostic factors for mortality following interhospital transfers to the medical intensive care unit of a tertiary referral center. Crit Care Med. 2003;31(7):1981-6. https://doi.org/10.1097/01.CCM.0000069730.02769.16.
McPherson ML, Graf JM. Speed isn’t everything in pediatric medical transport. Pediatrics. 2009;124(1):381- 3. https://doi.org/10.1542/peds.2008-3596.
Odetola FO, Rosenberg AL, Davis MM, Clark SJ, Dechert RE, Shanley TP. Do outcomes vary according to the source of admission to the pediatric intensive care unit? Pediatr Crit Care Med. 2008;9(1):20-5. https://doi.org/10.1097/01.PCC.0000298642.11872.29.
Gregory CJ, Nasrollahzadeh F, Dharmar M, Parsapour K, Marcin JP. Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions. Pediatrics. 2008;121(4):e906-11. https://doi.org/10.1542/peds.2007-2089.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Scientia Medica
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright
The submission of originals to Scientia Medica implies the transfer by the authors of the right for publication. Authors retain copyright and grant the journal right of first publication. If the authors wish to include the same data into another publication, they must cite Scientia Medica as the site of original publication.
Creative Commons License
Except where otherwise specified, material published in this journal is licensed under a Creative Commons Attribution 4.0 International license, which allows unrestricted use, distribution and reproduction in any medium, provided the original publication is correctly cited.
