Abstract
BackgroundWe aimed to evaluate the effects of interfacility pediatric critical care transport response time, physician presence during transport, and mode of transport on mortality and length of stay (LOS) among pediatric patients. We hypothesized that a shorter response time and helicopter transports, but not physician presence, are associated with lower mortality and a shorter LOS.MethodsRetrospective, single-center, cohort study of 841 patients (< 19 years) transported to a quaternary pediatric intensive care unit and cardiovascular intensive care unit between 2014 and 2018 utilizing patient charts and transport records. Multivariate linear and logistic regression analyses adjusted for age, diagnosis, mode of transport, response time, stabilization time, return duration, mortality risk (pediatric index of mortality-2 and pediatric risk of mortality-3), and inotrope, vasopressor, or mechanical ventilation presence on admission.ResultsFour hundred and twenty-eight (50.9%) patients were transported by helicopter, and 413 (49.1%) were transported by ambulance. Physicians accompanied 239 (28.4%) transports. The median response time was 2.0 (interquartile range 1.4–2.9) hours. Although physician presence increased the median response time by 0.26 hours (P = 0.020), neither physician presence nor response time significantly affected mortality, ICU length of stay (ILOS) or hospital length of stay (HLOS). Helicopter transports were not significantly associated with mortality or ILOS, but were associated with a longer HLOS (3.24 days, 95% confidence interval 0.59–5.90) than ambulance transports (P = 0.017).ConclusionsThese results suggest response time and physician presence do not significantly affect mortality or LOS. This may reflect the quality of pre-transport care and medical control communication. Helicopter transports were only associated with a longer HLOS. Our analysis provides a framework for examining transport workforce needs and associated costs.
Highlights
No evidence-based pediatric guidelines exist that define the requirement for physician presence on interfacility transports, the ideal mode of transportation, or limitations of mobilization and travel times to and from outside facilities due, in part, to the paucity of studies in this field [1,2,3,4]
Helicopter transports resulted in an average increase in hospital length of stay (HLOS) of 3.24 days, but not in intensive care unit (ICU) length of stay (ILOS)
We elected to perform a propensity score matched analysis with the same variables to confirm our multivariable model estimates for both the effect of physician presence and helicopter transports on our three outcomes of interest
Summary
No evidence-based pediatric guidelines exist that define the requirement for physician presence on interfacility transports, the ideal mode of transportation, or limitations of mobilization and travel times to and from outside facilities due, in part, to the paucity of studies in this field [1,2,3,4]. Only one study has compared specialty pediatric transport teams with and without a physician, and no differences in mortality were seen when adjusted for the severity of illness of the transported patients [12]. When comparing air versus ground transports, studies have suggested that helicopters are faster at transporting patients than ambulances [14] and are associated with improved survival in adult [15] and pediatric trauma patients [16,17,18]. Conclusions These results suggest response time and physician presence do not significantly affect mortality or LOS. This may reflect the quality of pre-transport care and medical control communication. Our analysis provides a framework for examining transport workforce needs and associated costs
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
