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Abstract

Introduction: Neurologic diagnoses (ND), in particular traumatic brain injury, account for significant morbidity and mortality in hospitalized children. Data on interfacility transport of patients with non-traumatic ND are lacking. The purposed of the study is to describe interfacility transport of children with and without ND by a specialized pediatric transport team. The long term objective is to use findings to inform treatment protocols and improve patient outcomes. Methods: Patients aged 1 month to 21 years that underwent interfacility transport by a non-trauma pediatric critical care transport team between October 1997 and February 2013 were studied from a prospectively collected database. Patients were categorized as having ND versus other diagnosis (OD) using data at hospital discharge. Groups were compared using Mann-Whitney U test. Univariate analysis identified variables that predict survival and a multivariate regression model was used to determine association with survival. Results: 12,855 patients met inclusion criteria. 2,155 with a ND, and 10,730 with OD. Children with ND were older (36m (IQR 83) vs 20 m (IQR 70)), had a higher median pre-hospital PRISM (6 (IQR 10) vs 0 (IQR 4)), a lower median GCS (10 (IQR 8) vs 14 (IQR 3)). In transport, children with ND had longer scene time in minutes (25 (IQR 22) vs 18 (IQR15)), were more likely to receive IV access (91 vs 80% (OR=2.6 [2.2-3.1])), interosseous access (5.2 vs 2.1% (OR=2.5 [2.0-3.2])) or intubation (36.3 vs 18.5% (OR 2.5 [2.3-2.8])), and were more likely to be admitted to the intensive care unit (ICU) (47.9 vs 36.7 % (OR 1.7 [1.5-1.8])) compared with children with OD. Children with ND had longer ICU and hospital length of stay and were more likely to die in the hospital (6.5 vs 4.4% (OR=1.5 [1.2-1.8])) than children with OD (all p<0.001). After accounting for variables that predicted survival in univariate analyses (PRISM, GCS, intubation status), a multivariate regression model showed that ND is associated with worse survival (negative coefficient) while transport time and mode of transport were not related to survival. The most frequent ND were seizure (66%), infection (11.5%) and anatomic abnormality (8.5%). Conclusions: In a population of children with non-traumatic ND, children with ND received more critical care interventions in transport, used more hospital resources and had worse outcomes than children with OD. Future directions include identifying interventions that may improve pre-hospital care and outcomes.