Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Assessment of interhospital transport care for pediatric patients

  • Chaichotjinda, Krittiya (Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University) ;
  • Chantra, Marut (Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University) ;
  • Pandee, Uthen (Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University)
  • Received : 2019.01.03
  • Accepted : 2019.08.27
  • Published : 2020.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Many critically ill patients require transfer to a higher-level hospital for complex medical care. Despite the publication of the American Academy of Pediatrics guidelines for pediatric interhospital transportation services and the establishment of many pediatric transport programs, adverse events during pediatric transport still occur. Purpose: To determine the incidence of adverse events occurring during pediatric transport and explore their complications and risk factors. Methods: This prospective observational study explored the adverse events that occurred during the interhospital transport of all pediatric patients referred to the pediatric intensive care unit of Ramathibodi Hospital between March 2016 and June 2017. Results: There were 122 pediatric transports to the unit. Adverse events occurred in 25 cases (22%). Physiologic deterioration occurred in 15 patients (60%). Most issues (11 events) involved circulatory problems causing patient hypotension and poor tissue perfusion requiring fluid resuscitation or inotropic administration on arrival at the unit. Respiratory complications were the second most common cause (4 events). Equipment-related adverse events occurred in 5 patients (20%). The common causes were accidental extubation and endotracheal tube displacement. Five patients had both physiologic deterioration and equipment-related adverse events. Regarding transport personnel, the group without complications more often had a physician escort than the group with complications (92% vs. 76%; relative risk, 2.4; P=0.028). Conclusion: The incidence of adverse events occurring during the transport of critically ill pediatric patients was 22%. Most events involved physiological deterioration. Escort personnel maybe the key to preventing and appropriately monitoring complications occurring during transport.

Keywords

References

  1. Hatherill M, Waggie Z, Reynolds L, Argent A. Transport of critically ill children in a resource-limited setting. Intensive Care Med 2003;29:1547-54. https://doi.org/10.1007/s00134-003-1888-7
  2. Droogh JM, Smit M, Absalom AR, Ligtenberg JJ, Zijlstra JG. Transferring the critically ill patient: are we there yet? Crit Care 2015;19:62. https://doi.org/10.1186/s13054-015-0749-4
  3. Limprayoon K, Sonjaipanich S, Susiva C. Transportation of critically ill patient to Pediatric Intensive Care Unit, Siriraj Hospital. J Med Assoc Thai 2005;88 Suppl 8:S86-91.
  4. American Academy of Pediatrics Committee on Hospital Care: Guidelines for Air and Ground Transportation of Pediatric Patients. Pediatrics 1986;78:943-50.
  5. Orr RA, Felmet KA, Han Y, McCloskey KA, Dragotta MA, Bills DM, et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics 2009;124:40-8. https://doi.org/10.1542/peds.2008-0515
  6. Stroud MH, Trautman MS, Meyer K, Moss MM, Schwartz HP, Bigham MT, et al. Pediatric and neonatal interfacility transport: results from a national consensus conference. Pediatrics 2013;132:359-66. https://doi.org/10.1542/peds.2013-0529
  7. Ramnarayan P, Thiru K, Parslow RC, Harrison DA, Draper ES, Rowan KM. Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study. Lancet 2010;376:698-704. https://doi.org/10.1016/S0140-6736(10)61113-0
  8. Barry PW, Ralston C. Adverse events occurring during interhospital transfer of the critically ill. Arch Dis Child 1994;71:8-11. https://doi.org/10.1136/adc.71.1.8
  9. Kanter RK, Tompkins JM. Adverse events during interhospital transport: physiologic deterioration associated with pretransport severity of illness. Pediatrics 1989;84:43-8.
  10. Giardino AP, Tran XG, King J, Giardino ER, Woodward GA, Durbin DR. A longitudinal view of resident education in pediatric emergency interhospital transport. Pediatr Emerg Care 2010;26:653-8. https://doi.org/10.1097/PEC.0b013e3181ef0473
  11. Edge WE, Kanter RK, Weigle CG, Walsh RF. Reduction of morbidity in interhospital transport by specialized pediatric staff. Crit Care Med 1994;22:1186-91. https://doi.org/10.1097/00003246-199407000-00023
  12. Vos GD, Nissen AC, H M Nieman F, Meurs MMB, van Waardenburg DA, Ramsay G, et al. Comparison of interhospital pediatric intensive care transport accompanied by a referring specialist or a specialist retrieval team. Intensive Care Med 2004;30:302-8. https://doi.org/10.1007/s00134-003-2066-7
  13. Britto J, Nadel S, Maconochie I, Levin M, Habibi P. Morbidity and severity of illness during interhospital transfer: impact of a specialised paediatric retrieval team. BMJ 1995;311:836-9. https://doi.org/10.1136/bmj.311.7009.836
  14. Venkataraman ST, Rubenstein JS, Orr RA. Interhospital transport. A pediatric perspective. Crit Care Clin 1992;8:515-23. https://doi.org/10.1016/S0749-0704(18)30238-0
  15. Warren J, Fromm RE Jr, Orr RA, Rotello LC, Horst HM; American College of Critical Care Medicine. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med 2004;32:256-62. https://doi.org/10.1097/01.CCM.0000104917.39204.0A
  16. Jouvet P, Lacroix J. Improving interhospital paediatric transport. Lancet 2010;376:660-1. https://doi.org/10.1016/S0140-6736(10)61110-5

Cited by

  1. Pediatric transport medicine: a yet unknown territory in Korea vol.63, pp.5, 2020, https://doi.org/10.3345/cep.2019.01270
  2. The Evaluation of Transported Children to Pediatric Intensive Care Unit: Indications, Problems, and Outcomes vol.40, pp.4, 2021, https://doi.org/10.1016/j.amj.2021.03.013
  3. Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals vol.38, pp.1, 2020, https://doi.org/10.1111/jrh.12566