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Utilizing Pediatric Scoring Systems to Predict Disposition During Interfacility Transport

Tanya Holt, Michael Prodanuk, Gregory Hansen

    Prehospital Emergency Care
    |August 18, 2018
    PubMed

    Insights

    Pediatric transport severity scoring systems like PedCTAS, TPEWS, and TRAP effectively predict pediatric intensive care unit admissions. The PRISM III score was not predictive for PICU admissions in this study.

    Area of Science:

    • Pediatric critical care medicine
    • Transport medicine
    • Health informatics

    Background:

    • Interfacility transport of pediatric patients presents challenges in determining appropriate care disposition.
    • Severity of illness scoring systems can aid in matching patient acuity with necessary care levels.

    Purpose of the Study:

    • To compare the effectiveness of currently used scoring systems in matching pediatric transport patients' severity of illness with required care levels.

    Main Methods:

    • Retrospective review of a regional transport registry (2015-2016) including 209 pediatric patients.
    • Calculation and comparison of Pediatric RISk of Mortality III (PRISM III), Canadian Pediatric Triage and Acuity Scale (PedCTAS), Transport Pediatric Early Warning Scores (TPEWS), and Transport Risk Assessment in Pediatrics (TRAP) scores.
    • Descriptive statistics, binomial logistic regression, and kappa statistics for interrater reliability were used.

    Main Results:

    • PedCTAS (score 1), TPEWS (score ≥6 or category 3), and TRAP (score ≥4) were significantly associated with pediatric intensive care unit (PICU) admission.
    • Odds ratios for PICU admission were 37.2 for PedCTAS, 42.2 for TPEWS, and 7.2 for TRAP.
    • PRISM III scores did not predict PICU admissions.

    Conclusions:

    • Elevated PedCTAS, TPEWS, and TRAP scores are strongly associated with PICU admission in the interfacility pediatric transport setting.
    • These scoring systems demonstrate utility in guiding care disposition for critically ill pediatric patients during transport.
    Abstract

    Keywords:
    critical illnesspatient acuitypediatricstransportation of patientstriage

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