Admission predictor modeling in pediatric interhospital transport
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Robert J Freishtat1, Bruce L Klein, Stephen J Teach
1Division of Emergency Medicine, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, DC 20010-2970, USA. rfreisht@cnmc.org
Insights
The pediatric risk of admission score does not reliably predict hospital or ICU admission for pediatric interhospital transports. Calibration may improve its use for transport triage and resource allocation.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Systems Research
- Patient Triage
Background:
- Interhospital transport of pediatric patients is common.
- Accurate severity of illness measures are needed for effective triage and resource allocation.
- Existing general severity of illness measures may not be optimized for transport populations.
Purpose of the Study:
- To evaluate the predictive utility of the pediatric risk of admission score for hospital and intensive care unit (ICU) admission in pediatric interhospital transports.
- To determine if a general severity of illness measure, calculated at referring hospitals, can predict outcomes at receiving hospitals.
Main Methods:
- A prospective study of 1920 consecutive pediatric interhospital transports to a tertiary care center over 1 year.
- The pediatric risk of admission score was calculated by the transport team leader at the referring hospital.
- Logistic regression and receiver operating characteristic curves were used to analyze prediction of hospital and ICU admission.
Main Results:
- The pediatric risk of admission score showed poor predictive performance for hospital admission (AUC = 0.612).
- Predictive performance for ICU admission was only slightly better (AUC = 0.721).
- Factors associated with hospital admission included higher age, higher score, trauma diagnosis, and lack of a pediatric inpatient service at the referring hospital.
Conclusions:
- The current form of the pediatric risk of admission score is not practical for predicting hospital or ICU admission in pediatric interhospital transport.
- Specific calibration of the score for the transport population could enhance its utility.
- Improved prediction may lead to more effective triage and resource allocation for pediatric transports.
Objective:
The objective of this investigation was to determine if an existing general severity of illness measure describing pediatric emergency patients, calculated at referring hospitals, predicts the need for hospital admission and intensive care unit (ICU) admission at receiving hospitals.
Methods:
A consecutive series of interhospital transports to an urban pediatric tertiary care hospital from other emergency departments (EDs) during a 1-year period were studied. The pediatric risk of admission score, a validated emergency department measure of severity of illness, was calculated by the transport team leader on arrival at the referring hospital using data available at that time. Outcomes examined in a logistic regression model and receiver operating characteristic curves included the need for hospital admission and ICU admission.
Results:
From 52 referring emergency departments, 1920 consecutive interhospital transport records were analyzed. Of these, 1557 (81.1%) patients were ultimately admitted to the receiving hospital, including 131 (6.8%) to the ICU. Logistic regression for hospital admission demonstrated a significant independent association with higher age, higher pediatric risk of admission, trauma diagnosis, and the lack of a pediatric inpatient service. The receiver operating characteristic curve for hospital admission [area under the curve = 0.612 (0.576, 0.647)] was not useful to determine a suitable cut point below which hospital admission was unlikely to occur. Pediatric risk of admission score performance as a predictor of ICU admission by receiver operating characteristic curve was only slightly better (area under the curve = 0.721 [0.653, 0.788]).
Conclusions:
This form of the pediatric risk of admission score is not practical as a predictor of hospital and ICU admission among pediatric interhospital transport. Specific calibration could increase its utility for the transport population. This in turn may contribute to more effective interhospital transport triage and more efficient allocation of transport resources.
