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Transport-related adverse events in critically-ill children: The role of a dedicated transport team
Indian Pediatrics, 2017
ObjectiveTo compare the frequency of transport-related adverse events in children during specialized, non-specialized or unassisted transports.MethodsPatients were grouped based on transport team involved – specialized (Group-1); non-specialized (Group-2); unassisted transport (Group-3). Demographics, events during transport and condition on arrival were recorded.ResultsGroup-1 children had a lower incidence of adverse events compared to Group-2 and Group-3 (4.3%, 82.6% and 85.4% respectively; P<0.001). At arrival, children in Group-1 had a lower incidence of respiratory distress and airway compromise (P< 0.001).ConclusionTransport of critically ill children by a specialized transport team is associated with fewer transport-related adverse events.
Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2017
The transport of critically ill patients for procedures or imaging outside the Intensive Care Unit (ICU) is potentially hazardous; hence, the transport process must be organized and efficient. The literature about benefits of and untoward events (UEs) during intrahospital transport of pediatric critically ill patient is scarce. We, therefore, audited the UEs during and benefits of intrahospital transport of critically ill pediatric patients in our ICU. Eighty critically ill pediatric (<18 years) cancer patients, transported from the ICU for either diagnostic or therapeutic procedure over a period of 6 months, were included in the study. The data collected included the destination (computed tomography scan, intervention radiology, magnetic resonance imaging scan, and operation theater), accompanying medical personnel, UEs, and benefits obtained during transport. Among eighty pediatric patients, the median age was 8 years (range 2-17 years). During the transport, four (5%) patients...
Indian Journal of Critical Care Medicine, 2015
Background and Objectives: Prehospital transport practices prevalent among children presenting to the emergency are under-reported. Our objectives were to evaluate the prehospital transport practices prevalent among children presenting to the pediatric emergency and their subsequent clinical course and outcome. Methods: In this prospective observational study we enrolled all children ≤17 years of age presenting to the pediatric emergency (from January to June 2013) and recorded their demographic data and variables pertaining to prehospital transport practices. Data was entered into Microsoft Excel and analyzed using Stata 11 (StataCorp, College Station, TX, USA). Results: A total of 319 patients presented to the emergency during the study period. Acute gastroenteritis, respiratory tract infection and fever were the most common reasons for presentation to the emergency. Seventy-three (23%) children required admission. Most commonly used public transport was auto-rickshaw (138, 43.5%) and median time taken to reach hospital was 22 min (interquartile range: 5, 720). Twenty-six patients were referred from another health facility. Of these, 25 were transported in ambulance unaccompanied. About 8% (25) of parents reported having diffi culties in transporting their child to the hospital and 57% (181) of parents felt fellow passengers and drivers were unhelpful. On post-hoc analysis, only time taken to reach the hospital (30 vs. 20 min; relative risk [95% confi dence interval]: 1.02 [1.007, 1.03], P = 0.003) and the illness nature were signifi cant (45% vs. 2.6%; 0.58 [0.50, 0.67], P ≤ 0.0001) on multivariate analysis. Conclusions: In relation to prehospital transport among pediatric patients we observed that one-quarter of children presenting to the emergency required admission, the auto-rickshaw was the commonest mode of transport and that there is a lack of prior communication before referring patients for further management.
Interhospital Transport of Pediatric Patients in Denmark
Pediatric Emergency Care, 2018
Objectives: No national guidelines exist in Denmark regarding interhospital transport of critically ill children. The aim of this study was to disclose which physicians actually accompany critically ill children during interhospital transports nationwide and whether the physicians have adequate clinical skills to perform interhospital transfers. Methods: A questionnaire was sent to the youngest pediatrician on-call at every hospital in Denmark receiving pediatric emergencies except the tertiary Copenhagen University Hospital, Rigshospitalet. Results: Seventeen pediatric departments were contacted (response rate, 100%). All departments indicated that they perform interhospital transport of pediatric patients. When presented with 5 cases, great heterogeneity in the choice of transport physician and accompanying staff was seen. With increasing severity, fewer pediatricians were willing to transport the children (24% vs 6%). Irrespective of the degree of severity, more transports were delegated to anesthesiologists than performed by pediatricians. Pediatricians who agreed to transport the infant and neonate had adequate competencies. In cases with older children, 0 to 75% of physicians who would do the transport had adequate clinical skills and experience in emergency pediatric respiratory and cardiovascular management. Training in interhospital transport was offered by 1 department; 6 departments (35%) had local guidelines describing the management of pediatric transports. Conclusions: Great heterogeneity was found in the local transport strategies and practical skill sets of accompanying physicians. Overall, there is room for improvement in the management of interhospital transport of critically ill children in Denmark, perhaps by increasing the availability of specialized pediatric transport services for critically ill children nationwide.
Use of a physiologic scoring system during interhospital transport of pediatric patients
2001
To determine the incidence of physiologic deterioration in critically ill and injured pediatric patients during interhospital transport with air and ground ambulance Design: Prospective, descriptive study Setting: All children were treated in regional hospitals and then transported to a pediatric tertiary care center. Patients: Children (n = 100) with a median age of 1.4 years (range 1 week to 18 years) Main results: Three sets of physiologic scores were calculated: at the time of referral, on departure from the referring hospital, and arrival at the tertiary care center. The incidence of significant physiologic deterioration based on the calculated physiologic scores was 5.6% (n = 4) during ground and 3.4% (n = 1) during air ambulance transports. Critical events occurred in 15% of ground and 31% of air ambulance transports. Conclusion: No difference existed in the incidence of adverse events or physiologic deterioration when air ambulance transports were compared with ground ambulance transports for critically ill children by our team. The physiologic scoring system we chose is simple and easy to use for quality assurance.
Interhospital transport of pediatric patients requiring emergent care: current status in Turkey
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2004
This study was designed to evaluate the current situation of interhospital transport of pediatric patients requiring emergent care. Using a clinical prospective and multicenter design, 1,666 interhospital transports of pediatric patients were evaluated in 18 centers. Non-emergency transports and newborn transports were not included, so 854 transports were eligible for evaluation. Data were collected by means of a comprehensive form filled by a physician at the receiving hospital. The physicians who gave the decisions for the transports were pediatricians in 60%, general physicians in 15.4%, and residents in 6%, while no identification existed in 159 transports (18.6%). The receiving hospitals were not notified prior to the transport in 79.3%. Pretransport information about the patients were adequate in 26.1% and inadequate in 31.8%; no information was available in 42.1%. Ambulances were used in 64.4% of the transports, of which only 16.2% was fully equipped. Unqualified or inexperie...
Transportation of critically ill patient to Pediatric Intensive Care Unit, Siriraj Hospital
2005
This retrospective study was undertaken to evaluate and identify some difficulties encountered in the process of interhospital transport of pediatric critically ill patients from remote hospitals to the Pediatric Intensive care unit (PICU) of the Department of Pediatrics, Faculty of Medicine Siriraj Hospital. The study was conducted between 1st June, 2001 and 30th June, 2003. Total number of patients transferred to PICU were 36. Most patients suffered from respiratory diseases (14 cases, 38.9%) and cardiovascular diseases (8 cases, 22.2%) prior to transfer. Five patients (13.9%) had cardiac arrest and required CPR prior to the transfers. Twelve cases (30%) were transferred at the parents' request or and due to socioeconomic problems. All patients were transported by ambulance. The longest transfer duration was from a hospital in Chiangmai province (11 hours by road transfer). The majority of accompanying medical personnel were nurses (55.5%) with no experience in intensive care ...
Outcome of children transported for pediatric intensive care to a tertiary care setting in Sri Lanka
Sri Lanka Journal of Child Health, 2016
Introduction: Patient transport remains a necessary facet of today's health care environment and transport conditions bear a major impact on the outcome. There is a recent move in Sri Lanka to establish retrieval teams. Thus, identifying problems faced by the present system will be of utmost importance in development of transport teams. Objective: To evaluate the present system of transportation of sick children to the Medical Intensive Care Unit (MICU), Lady Ridgeway Hospital for Children (LRH), Colombo. Method: A prospective, descriptive, observational study of transferred patients was conducted at the MICU LRH, Colombo. All children admitted to MICU from 1 st March 2014 to 1 st June 2014 were included in the study. Data was collected using a selfadministered questionnaire. The Wilcoxon significant rank test and the Chi squared test were utilized in statistical analysis. Results: There were 200 patients comprising 105 (52.5%) out-of-hospital transfers and 95 (47.5%) inhospital transfers. Of the admissions, 72% were live discharges while 28% expired; 42.5% of transfers were from the Colombo district. Pneumonia was the ___________________________________________
Pediatric Interhospital Transport: Diagnostic Concordance and Hospital Mortality
Pediatric Critical Care Medicine, 2006
Introduction: Sedation is often necessary for pediatric ICU patients, but determining the optimal dose in medically complex patients is challenging. The Bispectral Index (BIS) is a processed electroencephalographic (EEG) variable that measures the hypnotic effects of various anesthetic and sedative agents. Thus, it is an objective indicator of a patient's level of consciousness. BIS has been validated as a measurement of hypnosis in adults, but there is little data on it's use in the pediatric ICU. The 3 main objectives of our study were to: 1) correlate BIS to the Comfort Score, a validated sedation score for mechanically ventilated and sedated children; 2) evaluate the impact of abnormal baseline mental status on the correlation of the BIS and Comfort Score; 3) determine the BIS score which correlates best with the optimal degree of sedation for these patients. Methods: The study is being conducted in a prospective, cohort, nonrandomized, blinded fashion. Sixty children will be enrolled in the study, and will be divided into two groups of thirty each. Group 1 includes children with normal baseline mental status admitted to the ICU and requiring sedation and mechanical ventilation for non-neurologic reasons. Group 2 includes children with abnormal baseline mental status undergoing elective surgery that requires postoperative mechanical ventilation and sedation. The BIS result and the Comfort Score are concurrently recorded hourly for 24 hrs. The nurse performing the Comfort Score is blinded to the BIS result. Since we are analyzing the correlation between two variables expected to change together, we have utilized a linear regression analysis by the Pearson's product-moment correlation coefficient. Results: The Pearson's coefficient for group 1 is 0.07, indicating weak positive correlation, with an N of 161 data points (12 patients). The Pearson's coefficient for group 2 was Ϫ0.135, indicating a weak negative correlation, with an N of 180 data points (14 patients). Conclusion: Although the Comfort Score has been clinically validated and shown to have good interrater reliability, it remains a subjective scoring system. The Comfort Score for patients with abnormal baseline motor function or patients receiving neuromuscular blockade may be misleading, since a portion of the score is related to spontaneous movement. Our results indicate a weak correlation between the Comfort Score and BIS in children who were neurologically normal at baseline. This poor correlation may be secondary to the lack of adequate numbers to power the study, or due to the inherent weakness of the Comfort Score as noted above. There may also be significant differences in the correlation of BIS to Comfort Score in young children, as their EEG's differ from that of a normal adult, especially in children Ͻ3 yrs old. Half of our patients in group 1 were Ͻ3 yrs old. The negative correlation in children with an abnormal baseline mental status indicates the BIS may be unreliable for this patient population. Due to poor correlation, the BIS score that indicates optimal sedation in mechanically ventilated children has yet to be determined. Additional data is needed before the BIS can be reliably used for children in the PICU setting.
Reverse transport of children from a tertiary pediatric hospital
Air Medical Journal, 2007
The purpose of this study was to determine the epidemiology and resources used and to study the potential savings of pediatric reverse transport patients. Methods: A case control study was performed with patients undergoing a reverse or outbound transport from a large, pediatric hospital. Twenty-five children undergoing reverse transport were compared with matched controls. Lengths of stay and costs were compared between the reverse transport and matched control patients. Results: Fifty-two percent of the reverse transport patients returned home, whereas 32% went home for end-of-life care and 16% went to other facilities. The average reverse transport was more than 400 miles and cost $6,064.The reverse transport of these patients did not save pediatric intensive care unit (PICU) days but did result in a shorter hospital stay compared with the matched controls (10 vs. 19 days, P = .03). Decreased utilization of bed days came from less use of intermediate care unit resources. Conclusions: Pediatric patients undergo reverse transports for a variety of reasons, often for end-of-life care. The ability to reverse transport pediatric patients may not save PICU bed days but may offer pediatric tertiary care hospitals a means to provide more intermediate care bed availability.