Adverse Events During Intrahospital Transport of Critically Ill Children: A Systematic Review

Abstract

Intrahospital transport of a critically ill patient is often required to achieve a diagnostic and/or therapeutic objective. However, clinicians who recommend a procedure that requires transport are often not fully aware of the risks of transport. Clinicians involved in the care of critically ill children may therefore benefit from a clear enumeration of adverse events that have occurred during transport, risk factors for those events, and guidance for event prevention. The objective of this review was to collect all published harm and adverse events that occurred in critically ill children in the context of transport within a medical center, as well as the incidence of each type of event. A secondary objective was to identify what interventions have been previously studied that reduce events and to collect recommendations for harm prevention from study authors. Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and CINAHL were searched in January 2018 and again in December 2018. Terms indicating pediatric patients, intrahospital transport, critical illness, and adverse events were used. Titles and abstracts were screened and full text was reviewed for any article meeting inclusion criteria. If articles included both children and adults, incidence data were collected only if the number of pediatric patients could be ascertained. Of 471 full-text articles reviewed, 40 met inclusion criteria, of which 24 included only children, totaling 4104 patient transports. Heterogeneity was high, owing to a wide range of populations, settings, data collection methods, and outcomes. The incidence of adverse events varied widely between studies. Examples of harm included emergent tracheostomy, pneumothorax, and cardiac arrest requiring chest compressions. Respiratory and airway events were the most common type of adverse event. Hypothermia was common in infants. One transport-associated death was reported. When causation was assessed, most events were judged to have been preventable or potentially mitigated by improved double-checks and usage of checklists. Prospective studies demonstrated the superiority of mechanical ventilation over manual ventilation for intubated patients. Risk of adverse events during critical care transport appears to relate to the patient’s underlying illness and degree of respiratory support. Recommendations for reducing these adverse events have frequently included the use of checklists. Other recommendations include optimization of the patient’s physiological status before transport, training with transport equipment, double-checking of equipment before transport, and having experienced clinicians accompany the patient. All available recommendations for reducing transport-associated adverse events in included articles were collated and included.

Adverse Events and Associated Factors During Intrahospital Transport of Newborn Infants

“…Yet, the rate of complicated transports (25%) is at the low end of previous reports (25-80%) in adults, children, and newborns (1-7, 11, 24-26). In contrast to studies performed in children and adults, we did not observe any transport-related life-threatening or fatal adverse events such as cardiac arrest or unplanned extubation (9,11). AEs were mainly related to instability of the cardiovascular and respiratory systems, agitation, and temperature control.…”

“…Critically ill adult and pediatric patients transported during mechanical ventilation or hemodynamic support are at the greatest risk of AEs (1,3,5,9). We found that hemodynamic support with catecholamines or prostaglandins, and the presence of a central venous catheter were strongly associated with AEs.…”

“…Adverse events (AEs), including life-threatening complications, occur during intra-hospital transport of critically ill adults and children. Up to 80% of intra-hospital transports are associated with AEs such as desaturation, agitation, hemodynamic instability, arrhythmia, hypothermia, and equipment-related problems (1)(2)(3)(4)(5)(6)(7)(8)(9). Critically ill patients requiring mechanical ventilation, sedation, or hemodynamic support are at the highest risk of developing AEs (1,3,5).…”

Implementation of an Intrahospital Transport Checklist for Emergency Department Admissions to Intensive Care

“…Still, concerns for a Hawthorne effect limiting the internal validity of the checklist disallowed such a design. 33 …”

Monitoring During Transport

“…A recent systematic review specifically addresses adverse events during intrahospital transport of critically ill children. 31 This review included 24 studies with a total of 4,104 transports. In this group of pediatric subjects, respiratory and airway events were the most common adverse events, and the risk of an adverse event increased as the severity of underlying illness and the degree of respiratory support increased.…”