Pediatric risk of mortality (PRISM) score: A poor predictor in triage of patients for pediatric transport

Abstract

71 Variables Predicting the Need for Major Procedures During Pediatric Critical Care Transport KA McCIoskey, W King/The Children's Hospital, Harvard Medical School, Boston, Massachusetts; The Children's Hospital of Alabama Few standards exist for determinat ion of when to use a pediatric critical care transport team to transfer an acutely ill child from a nonpediatric hospital to a tertiary care center. This cross-sectional study evaluated clinical criteria to aid in that determination. Three hundred sixty-nine pediatric transports were evaluated by mult iple logistic regression analysis on six variables: age, vital signs, recent seizure activity, current endotracheal intubation, current respiratory distress, and respiratory diagnosis. The outcome variable was the need for major procedures (chest tube intubation, intraosseous infusion, umbil ical catheter placement) during transport. Major procedures were performed during 33 of the 369 transports (8.9 %). Patients wi th current in tubat ion had 2.1 t imes the odds of requiring a major procedure as compared wi th a nonin tuba ted pat ient (P = .07, alpha = .10). Patients less than 1 year of age wi th unstable vital signs had 6.4 t imes the odds of requiring a major procedure compared wi th patients in that age group wi th stable vital signs (P = .004). In patients older than or age l, vital sign stabili ty was not a significant factor (P = .41). If intubation, age, and vital sign status were used as above to determine the use of the transport team, 113 of the 369 transports (30%) would have used the team. The true-positive rate, that is, cases in which the procedural expertise of the t eam/MD was needed, would have been 18.6%. The false-negative rate, tha t is, cases in which the t eam/MD was not used but procedural expertise was needed was 4.9%.