Pediatric Interfacility Transfers – Association of Pre-transfer Vital Signs with Length of Stay at a Tertiary Care Center

Abstract

Objective: Determine which abnormal pre-transfer vital signs predict longer length of stay (LOS) for pediatric patients transferred to a tertiary care center. Patients and Methods: A retrospective study of all patients transferred between Aug 2016 and Jan 2017 to Maine Medical Center’s pediatric inpatient units, PICU, and Emergency Department with pediatric consult. Charts were examined for pre-transfer vital signs and diagnosis. The primary outcome of interest was LOS. Vital signs were determined to be normal or abnormal using the 2015 PALS Guidelines. Results: Two hundred thirty-six pediatric patients were included. Median LOS was 42.5 hours; median age was 68.0 months. Patients with abnormal RRs before transfer have significantly longer LOS than patients with normal RRs (p= 0.017). Abnormal heart rate, temperature, and oxygen saturation did not predict LOS. Blood pressure (BP) was obtained in only 47.9% of patients; abnormal BP predicted a significantly longer LOS (p= 0.035). Conclusions: The predictive value of an abnormal vital sign in pediatric patients at pre-transfer hospitals varied. RR had a significant correlation with LOS in this tertiary care center, whereas heart rate, temperature, and oxygen saturation did not. Abnormality of BP, although only captured in fewer than half of patients, was associated with longer LOS. With more consistent monitoring in children, BP may also be a good predictor of LOS after transfer. These results may help guide both referring and accepting provider decision-making.