Aims & Objectives: Aim of this study is to evaluate the factors which predict mortality in patients who present to secondary care hospitals with acute surgical problems requiring transfer to tertiary care facility. The risk stratification will help acute care transfer teams to organize transport of these children more effectively, which would further help in reducing the mortality. Methods Paediatric critical care transfer referrals to North West & North Wales Transport Services in UK over the last 5 years were selected. The data is collected from the case notes which were recorded by the acute care transfer team, from the time the patient was first referred to the team by phone till 24 hours post transfer. Results During the study period there were 181 patients presented to district general hospitals in this region of UK with acute surgical problems and required critical care advice or transfer to higher centres. Preterm and Neonatal age group predominate among the study population (94/181=52%). Among the 181 patients, 170 patients required transferred to higher centre either for specialist opinion, surgery and/or critical care. There were 7 deaths during the study period, mortality being 7/181=3.9%. Lactate level >5, suspected sepsis, and haematological abnormality were strongly associated with mortality in our study population. 25 patients were transferred by local team with available medical personnel as time critical transfer based on the underlying condition. Conclusions High lactate is the most important single predictor in acute surgical paediatric patients who will require time critical transfer and also an important predictor of mortality.