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Cost-benefit of trained transport teams: estimates for head-injured children
A J Macnab1, D F Wensley, C Sun
1Department of Pediatrics, University of British Columbia, Vancouver, Canada. amacnab@cw.bc.ca
Insights
Training pediatric transport teams significantly reduces adverse events in head-injured children. This improved care offers substantial cost-benefits by preventing injury severity changes during transport.
Area of Science:
- Pediatric emergency medicine
- Transport medicine
- Health economics
Background:
- Transport care critically impacts head-injured children's outcomes.
- Hypotension and hypoxia during transport increase morbidity and mortality.
- Trained transport teams minimize secondary insults.
Purpose of the Study:
- To evaluate the cost-benefit of employing trained pediatric escort paramedics.
- To assess the impact of specialized training on patient outcomes during interfacility transport.
Main Methods:
- Retrospective review of pediatric head injury transports (n=43) over 12 months.
- Comparison of adverse events between untrained (UE) and trained escorts (TE).
- Severity assessment using Glasgow Coma Score (GCS); cost-benefit analysis of preventable insults.
Main Results:
- Trained escorts (TE) had significantly fewer preventable insults (12%) versus untrained (UE) (55%).
- No severe worsening of injury in the TE group, unlike the UE group.
- Estimated cost-benefit ranged from $136,000 (median) to $238,000 (mean).
Conclusions:
- Training pediatric transport escorts yields significant cost-benefits.
- Improved care during transport of head-injured children is crucial.
- Investment in specialized paramedic training is recommended.
Introduction:
Care during transport influences the outcome of head-injured children. Secondary adverse events, e.g., hypotension and hypoxia, worsen morbidity and mortality. Trained transport teams lower the incidence of such secondary "insults."
Objective:
To estimate the cost-benefit of improved care from trained escorts.
Methods:
The setting was a provincial air ambulance service during transition to trained pediatric escort paramedics. A retrospective review of transport and hospital records for a 12-month period was conducted. All children with head injuries (n = 43) transported to tertiary care [11 by untrained escorts (UE), 32 by trained escorts (TE)] were enrolled. Severity of injury was classified by Glasgow Coma Score (GCS); incidence of adverse events was counted and cost of change of severity resulting from preventable insults was estimated using published care costs.
Results:
There were 13 preventable insults in six patients (55%) in the UE group and five preventable insults in four patients (12%) in the TE group (p<0.05). Among those in the UE group, two changed in severity from moderate to severe, one moderate worsened (decrease in GCS of 2 or more), and two severe worsened. In the TE group, there were no changes >1. Cost-benefit estimates based on change in severity were $136,000 (median) to $238,000 (mean).
Conclusion:
Significant cost-benefit likely accrues from training escorts who transport children with significant head injuries to tertiary care.
