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Critical care pediatrician-led aeromedical transports: physician interventions and predictiveness of outcome
1Division of Pediatric Critical Care, University of Wisconsin Hospital and Clinics, Madison.
Insights
Pediatric transport teams may not always require a physician. Physician presence on transport could be reconsidered, as current severity of illness scoring is not accurate enough for decision-making.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Transport Medicine
Background:
- The University of Wisconsin Hospital and Clinics (UWHC) pediatric transport service reviewed its one-year experience.
- The transport team comprised a critical care flight nurse and a pediatric critical care physician.
Purpose of the Study:
- To assess the necessity of physician presence by analyzing physician interventions during pediatric transports.
- To identify predictive variables for patient outcomes using data from referral calls.
Main Methods:
- Review of 109 pediatric helicopter transports over one year.
- Analysis of interventions performed by physicians.
- Multivariate modeling to assess predictive value of variables like PRISM scores, age, gender, and distance.
Main Results:
- 30% of patients received no interventions; intubation rates were 18% for medical and 10% for trauma patients.
- Telephone Pediatric Risk of Mortality (PRISM) scores predicted outcome in only 38% of medical patients.
- Outcome prediction for trauma patients reached 74% when considering PRISM scores, age, gender, and distance.
Conclusions:
- Physician-accompanied pediatric transports may not be necessary unless benefits are proven.
- Current severity of illness scoring systems are not sufficiently accurate for determining transport appropriateness.
- Further research is needed to establish the value of physician presence in pediatric critical care transport.
Abstract:
This article reviews the one-year experience (March 28, 1987 to March 27, 1988) of the pediatric transport service of the University of Wisconsin Hospital and Clinics (UWHC). The UWHC pediatric transport team consisted of a critical care flight nurse and a pediatric critical care attending physician or fellow. The aims of the study were to: 1) determine the types and number of interventions performed by the physicians to gauge the need for physician presence on transport; and 2) determine which variables (severity of illness scores, age, gender, distance from hospital) recorded at the time of the referral telephone call best predicted outcome of the patient. There were 109 children transported by helicopter during the one-year study period. Thirty percent of the patients (43% of trauma patients and 22% of medical patients) had no interventions at all, 18% of medical patients and 10% of trauma patients were intubated, and 9% of medical patients and no trauma patients had central venous catheters inserted. Multivariate modeling determined that among medical patients, outcome could be accurately predicted only 38% of the time if telephone PRISM (Pediatric Risk of Mortality) scores were determined. Among trauma patients, if gender, age, distance from UWHC, and telephone PRISM scores were known, outcome could be predicted 74% of the time. Unless studies show the benefit of pediatrician-accompanied transport, transports could probably be done without critical care pediatricians. Severity of illness scoring at this time is probably not sufficiently accurate to warrant its use for deciding the appropriateness of transport of pediatric patients.