Excess morbidity associated with interhospital transport

Area of Science:

• Pediatric Critical Care Medicine
• Transport Medicine
• Patient Safety

Background:

• Interhospital transport of critically ill pediatric patients is common.
• The safety and morbidity associated with this transport are not fully understood.
• Existing transport teams may lack specialized critical care expertise.

Purpose of the Study:

• To investigate whether critically ill and injured pediatric patients experience excess morbidity during interhospital transport.
• To compare morbidity rates between transported patients and a control group receiving care within a pediatric intensive care unit (PICU).

Main Methods:

• Prospective study comparing 177 transported pediatric patients with 195 control patients.
• Control group received initial 2 hours of PICU care after emergent admission within the same institution.
• Morbidity and adverse events were recorded during the first 2 hours post-PICU admission or transport.

Main Results:

• Transported patients had significantly higher overall morbidity (20.9%) compared to controls (11.3%).
• Excess morbidity was driven by intensive care-related adverse events (15.3% vs. 3.6%) in transported patients.
• Physiologic deterioration rates were similar between groups, but pre-transport severity of illness was higher in the transported group.

Conclusions:

• Interhospital transport is associated with excess morbidity in critically ill pediatric patients, primarily due to intensive care-related adverse events.
• Even when controlling for severity of illness, transported patients showed higher rates of adverse events.
• Specialized transport teams may be necessary to mitigate the risks associated with pediatric interhospital transport.