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Variables predicting the need for a pediatric critical care transport team
K A McCloskey1, G Faries, W D King
1Department of Pediatrics, University of Alabama School of Medicine, Birmingham.
Insights
Pediatric critical care transport teams are needed for intubated patients, those under one year old with unstable vital signs, or both. These factors predict the need for major procedures, physician presence, and ICU-monitored medications.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medical Services
- Transport Medicine
Background:
- Determining the necessity of a specialized pediatric critical care transport team is crucial for optimal patient outcomes.
- Pre-transport assessment aids in resource allocation and ensuring appropriate medical expertise during transfers.
Purpose of the Study:
- To identify key predictors for requiring a pediatric critical care transport team.
- To develop a model for assessing the need for advanced interventions during interfacility pediatric transports.
Main Methods:
- A cross-sectional study analyzed 369 pediatric transports.
- Stepwise multiple logistic regression evaluated age, vital signs, seizure activity, endotracheal intubation, respiratory distress, and respiratory diagnosis.
- Outcomes included need for major procedures, physician presence, and use of ICU-monitored medications.
Main Results:
- Endotracheal intubation, age less than one year, and unstable vital signs significantly predicted the need for major procedures, physician presence, and ICU-monitored medications.
- Intubated patients, particularly those under one year with unstable vital signs, had a substantially higher probability of requiring intensive interventions.
- Other pre-transport variables were not significant predictors when analyzed alone or in pairs.
Conclusions:
- Endotracheal intubation, patient age, and vital sign status are reliable predictors for determining the need for a pediatric critical care transport team.
- These factors can guide decision-making for interfacility transfers, ensuring appropriate levels of care.
- The study provides a data-driven approach to optimize transport team deployment for critically ill children.
Abstract:
To determine when a pediatric critical care transport team is required to transport a patient to a referral center, this cross-sectional study evaluated 369 consecutive pediatric transports by stepwise multiple logistic regression analysis of six variables: age, vital signs, seizure activity, current endotracheal intubation, respiratory distress, and respiratory diagnosis. Models were developed for three outcome variables: 1) Major procedures were required in 8.9% of cases. The predicted probability of needing a major procedure was increased for intubated patients (probability of 12.9%), patients less than 1 year of age with unstable vital signs (12.9%), and patients meeting both these criteria (23.2%). 2) A posttransport assessment of need for a physician on the team was positive in 43% of cases. The probability of needing a physician was increased for intubated patients (probability of 68.8%), patients less than 1 year of age with unstable vital signs (58.7%), and patients meeting both these criteria (79.9%). 3) Category 1 drugs, ie, medications requiring ICU monitoring, were used in 19% of transports. The probability of this occurring was increased for intubated patients with stable vital signs (probability of 24.7%) and for intubated patients with unstable vital signs (41.4%). None of the other pretransport variables, alone or in pairs, was a significant predictor of any of the three outcome variables. The data indicate that intubation, age, and vital sign status can be used in predicting whether a transport team is needed.