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Do Pediatric Teams Affect Outcomes of Injured Children Requiring Inter-hospital Transport?
Insights
Pediatric transport teams (PTT) do not worsen outcomes for injured children, despite longer transport times. Severely injured children had shorter hospital stays when transported by PTT compared to air critical care.
Area of Science:
- Pediatric Trauma Care
- Emergency Medical Services
- Transport Medicine
Background:
- Pediatric trauma centers improve outcomes for injured children.
- Most children lack immediate access to specialized pediatric trauma care, necessitating local stabilization and transfer.
- Pediatric transport teams (PTT) are known to improve outcomes for critically ill children, but their impact on injured children is less understood.
Purpose of the Study:
- To determine if the use of PTT for inter-hospital transfer affects outcomes for injured children.
- To compare outcomes between children transported by PTT and those transported by ground advanced life support (ALS) or air critical care (ACC).
Main Methods:
- Retrospective chart review of 1,177 children transferred to a pediatric trauma center.
- Comparison of patient characteristics, transport times, hospital length of stay (LOS), transport interventions, and adverse events between PTT, ALS, and ACC.
- Statistical analysis controlling for age, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), transport mode, distance, and time.
Main Results:
- Children transported by PTT were younger and had higher ISS and lower GCS scores, indicating they were sicker.
- PTT transport involved longer total transport time, departure preparation time, and patient bedside time.
- No significant difference in hospital LOS was found between PTT, ALS, and ACC after controlling for key variables.
- A subgroup analysis revealed a 65% longer LOS for children with higher ISS scores transported by ACC compared to PTT.
- No differences were observed in acidosis, hypocarbia, hypercarbia, or maintenance of tubes and lines between transport groups.
Conclusions:
- Despite longer transport times, PTT for injured children did not result in longer hospital LOS or increased adverse events.
- For severely injured children (higher ISS), transport by ACC was associated with a longer hospital LOS compared to PTT.
- PTT is a safe and effective mode of transport for injured children, even those with severe injuries.
Introduction:
Studies show that pediatric trauma centers produce better outcomes and reduced mortality for injured children. Yet, most children do not have timely access to a pediatric trauma center and require stabilization locally with subsequent transfer. Investigators have demonstrated that pediatric transport teams (PTT) improve outcomes for critically ill children; however, these studies did not differentiate outcomes for injured children. It may be that moderate to severely injured children actually fare worse with PTT due to slower transport times inherent to their remote locations and thus delays in important interventions.
Objective:
The purpose of this study was to determine if outcomes for injured children are affected by use of PTT for inter-hospital transfer.
Methods:
We conducted a retrospective chart review of 1,177 children transferred to a pediatric trauma center for injury care between March 1st, 2012 and December 31st, 2013. We compared children who were transported by PTT (ground/air) to those transported by ground advanced life support (ALS) and air critical care (ACC). We described patient characteristics and transport times. For PTT vs. ALS and ACC, we compared hospital length of stay (LOS), transport interventions and adverse events.
Results:
1,177 injured children were transferred by the following modes: 68% ALS, 13% ACC, 11% Ground PTT, and 9% Air PTT. Children transported by PTT were younger and had higher ISS and lower GCS scores. PTT had a longer total transport time, departure preparation time, and patient bedside time. After controlling for age, ISS, GCS, transport mode, distance, and time, we found no significant difference in LOS between PTT vs. ALS and ACC. A subgroup analysis of children with higher ISS scores demonstrated a 65% longer LOS for children transported by ACC vs. PTT. There were no differences between transport teams with regard to acidosis, hypocarbia or hypercarbia, or maintenance of tubes and lines.
Conclusions:
Children transported by PTT were younger and sicker (vs. ACC and ALS). Despite longer transport times, children transported by PTT did not have a longer hospital LOS or adverse events during transport. However, for those children with higher ISS, transport by ACC resulted in longer hospital LOS vs. PTT.
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