Severity of illness and injury in pediatric air transport

To assess severity of illness or injury in pediatric patients undergoing air transport, we prospectively evaluated 636 patients during 29 months of service. All patients were classified by age, diagnosis, and method and distance of transport. Therapeutic intervention scoring system (TISS) scores were calculated in all patients, Glasgow coma scale (GCS) scores were used in patients with altered level of consciousness, and Modified Injury Severity Scale (MISS) scores were used in patients with multiple trauma. A total of 57.5% of patients were transported by helicopter, 37.5% by fixed-wing aircraft, and 5% by ground transport. Mean distance of transport was 207 miles. Age ranged from 3 weeks to 16 years, with 45% of children under 1 year of age. Trauma (24.6%), neurologic disease (24.2%), and respiratory failure (20%) were the most common diagnoses. Eighty-one percent of patients were taken to surgery or admitted to the intensive care unit immediately on arrival at the regional children's hospital. Mean TISS score was 36.7, with 51% of patients having TISS scores greater than 30. The mean MISS score was 34.5, and 75% of patients had MISS scores greater than 25. Nineteen percent of patients had GCS scores less than or equal to 8. Overall mortality was 7%, with 9% mortality in patients with trauma versus 6.3% in nontraumatic diseases. TISS scores greater than 30, MISS scores greater than 25, and GCS scores less than or equal to 8 were associated with increased mortality (P less than .01).