Abstract
BackgroundCentralisation of paediatric intensive care units (PICUs) has the increased the need for specialist paediatric critical care transport teams (PCCT) to transport critically ill children to PICU. We investigated the impact of care provided by PCCTs for children on mortality and other clinically important outcomes.MethodsWe analysed linked national data from the Paediatric Intensive Care Audit Network (PICANet) from children admitted to PICUs in England and Wales (2014–2016) to assess the impact of who led the child’s transport, whether prolonged stabilisation by the PCCT was detrimental and the impact of critical incidents during transport on patient outcome. We used logistic regression models to estimate the adjusted odds and probability of mortality within 30 days of admission to PICU (primary outcome) and negative binomial models to investigate length of stay (LOS) and length of invasive ventilation (LOV).ResultsThe study included 9112 children transported to PICU. The most common diagnosis was respiratory problems; junior doctors led the PCCT in just over half of all transports; and the 30-day mortality was 7.1%. Transports led by Advanced Nurse Practitioners and Junior Doctors had similar outcomes (adjusted mortality ANP: 0.035 versus Junior Doctor: 0.038). Prolonged stabilisation by the PCCT was possibly associated with increased mortality (0.059, 95% CI: 0.040 to 0.079 versus short stabilisation 0.044, 95% CI: 0.039 to 0.048). Critical incidents involving the child increased the adjusted odds of mortality within 30 days (odds ratio: 3.07).ConclusionsVariations in team composition between PCCTs appear to have little effect on patient outcomes. We believe differences in stabilisation approaches are due to residual confounding. Our finding that critical incidents were associated with worse outcomes indicates that safety during critical care transport is an important area for future quality improvement work.
Highlights
Paediatric Critical Care Transport (PCCT) teams were developed following the centralisation of Paediatric Intensive Care Units (PICU) in the United Kingdom and in other parts of the world [1–4]
As part of DEPICT, we previously investigated the impact of the time taken by paediatric critical care transport teams (PCCT) to reach the bedside of critically ill children and concluded that the time does not appear to be associated with mortality [10]
Data sources Information about children transported by a PCCT to PICU were extracted from the Paediatric Intensive Care Audit Network (PICANet, https://www.picanet.org.uk/) which collects data related to the referral, transport and admission of every child requiring admission to a PICU
Summary
Paediatric Critical Care Transport (PCCT) teams were developed following the centralisation of Paediatric Intensive Care Units (PICU) in the United Kingdom and in other parts of the world [1–4]. PCCTs provide ‘intensive care on the move’ for critically ill children who require transport from general hospitals to PICUs – the arrival of the PCCT at the bedside of the child represents the first contact with an intensive care team. The Paediatric Intensive Care Audit Network (PICA Net), the national clinical audit of paediatric intensive care activity, reports considerable variation between PCCTs in terms of the time taken to reach a child’s bedside after agreeing the child requires intensive care, their team composition, the number and nature of interventions performed and the rate of critical incidents during transport [7]. We investigated the impact of care provided by PCCTs for children on mortality and other clinically important outcomes
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