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Assessing Pediatric Inter-Hospital Transfer: A single-center, Retrospective, Observational Study of Saudi Arabia's
Hakem Alomani1, Ahmed Ramadan2, Gehad Omran3
1Consultant, Pediatric critical care, Head of Pediatric Intensive Care Unit, Maternity and Children Hospital, Buriadah - KSA.
Insights
The Life-Saving Protocol (LSP) accurately triages pediatric patients with critical conditions. However, variations in identifying true emergencies were observed, suggesting areas for improvement in the protocol
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Systems Analysis
- Clinical Protocol Evaluation
Background:
- The Life-Saving Protocol (LSP) was developed to streamline the transfer of critically ill pediatric patients from peripheral to regional hospitals.
- Effective triage is crucial for managing patients with life or limb-threatening conditions.
Purpose of the Study:
- To evaluate the accuracy of the national Life-Saving Protocol (LSP) in Saudi Arabia.
- To assess the impact of LSP on pediatric patient outcomes, including mortality and length of stay.
Main Methods:
- A retrospective, single-center observational study was conducted over 12 months.
- Patients arriving via LSP to the pediatric emergency room were analyzed.
- A matched case-control study compared outcomes of PICU admissions via LSP versus other routes.
Main Results:
- Out of 118 patients arriving via LSP, only 43 (36%) had life or limb-threatening conditions requiring PICU admission.
- A significant proportion of patients (54%) were admitted to the general ward, and 8% were discharged home.
- PICU mortality for LSP patients was 13.9% compared to 4.6% in the control group (p=0.08).
Conclusions:
- The LSP is a valuable healthcare initiative but demonstrates variability in accurately identifying critically ill pediatric patients.
- Further national-level assessment is recommended to refine the LSP and improve its effectiveness.
Objective:
To examine the accuracy of our national Life-Saving Protocol (LSP). To the best of our knowledge, this is the first study addressing this issue in Saudi Arabia.
Background:
LSP was created to facilitate triaging patients with LIFE or LIMB threatening conditions in peripheral hospitals with limited services to large regional hospitals to receive definitive care.
Method:
This is a retrospective single-center observational study over 12 months studying the patients who arrived via LSP to our Emergency room (ED), at the only regional pediatric hospital. For the subgroup of patients who were admitted to PICU through LSP, we further assessed their outcomes like mortality and length of stay (LOS) through a matched case-control study of 1:1 with similar patients who were admitted to our PICU via other routes rather than LSP. The primary outcome is to assess the accuracy of the LSP in triaging pediatric patients with LIFE of LIMB conditions. Secondary outcomes include assessing the association between LSP and (mortality, LOS) for those who were admitted to the regional PICU via LSP compared to patients admitted to PICU via other sources of admission.
Results:
During the study period, 118 patients arrived at our ED via LSP. Only 43 patients (36 %) were admitted to the PICU with LIFE or LIMB conditions. A total of 64 patients (54%) of the patients were admitted directly to the general pediatric ward from ED level due to absence of LIFE of LIMB threatening condition and 8% (n=9) were discharged immediately home from the ED level due to lack of any significant illness. One patient died at ED level, and one was referred to another hospital with a minor orthopedic injury. For those who were admitted to the PICU via LSP, the mortality rate was (13.9%) (6/43), and the control group was (4.6%) (2/43) with a p-value of 0.08.
Conclusion:
LSP is an excellent initiative and essential tool in our healthcare system; however, our study showed huge variation in the ability of the system to recognize true pediatric patients with LIFE or LIMB conditions. Our study might form a stepping-stone in future studies assessing the LSP at the national level.
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