Interhospital Transport of Critically Ill Children to PICUs in the United Kingdom and Republic of Ireland: Analysis of an International Dataset*

Ramnarayan, Padmanabhan; Dimitriades, Konstantinos; Freeburn, Lynsey; Kashyap, A.; Dixon, Michaela; Barry, Peter; Claydon-Smith, K.; Wardhaugh, Allan; Lamming, Caroline R; Draper, Elizabeth S

doi:10.1097/pcc.0000000000001506

Cited by 32 publications

(40 citation statements)

References 18 publications

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“…24 Emergency and unplanned admissions to paediatric ICUs equal approximately 12,000 per year of which approximately 6000 are carried out by specialist transport teams. 25 Fifty six per cent (25/45) of the infants in this study had an antenatal diagnosis of which 92% (23/25) were born at the tertiary maternity unit. This is consistent with findings of previous studies that showed that the detection rate for infants with transposition of the great arteries is between 41 and 84%.…”

Section: Discussionmentioning

confidence: 78%

Do infants with transposition of the great arteries born outside a specialist centre have different outcomes?

Veal¹,

Hunt

Tume

2019

Cardiol Young

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Background:Infants born with undiagnosed transposition of the great arteries continue to be born in district general hospitals despite the improvements made in antenatal scanning. Evidence indicates improved outcomes with early definitive treatment after birth, hence the recommendation of delivery in a tertiary centre. The role of specialist paediatric and neonatal transport teams, to advise, stabilise, and transport the infants to a tertiary centre in a timely manner, is critical for those infants born in a district general hospital. This pilot study aims to compare outcomes between infants born in district general hospitals and those who were born in a tertiary maternity unit in South West England and South Wales.Methods:This was a secondary data analysis of data collected from the local Paediatric Intensive Care Audit Network and the local transport database. Infants born with a confirmed diagnosis of transposition of the great arteries, that required an arterial switch operation as the definitive procedure between April, 2012 and March 2018 were included.Results:Forty-five infants with a confirmed diagnosis of transposition of the great arteries were included. Statistical analysis demonstrated there were no significant differences in the time to balloon atrial septostomy (p = 0.095), time to arterial switch operation (p = 0.461), length of paediatric ICU stay (p = 0.353), and hospital stay (p = 0.095) or mortality between the two groups.Conclusions:We found no significant differences in outcomes between infants delivered outside the specialist centre, who were transferred in by a specialist team.

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Section: Discussionmentioning

confidence: 78%

Do infants with transposition of the great arteries born outside a specialist centre have different outcomes?

Veal¹,

Hunt

Tume

2019

Cardiol Young

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“…Multiple attempts at endotracheal intubation are associated with an increased complication rate . A team of skilled and experienced clinicians can safely undertake endotracheal intubation in the retrieval environment with a high first attempt success rate …”

Section: Discussionmentioning

confidence: 99%

Endotracheal intubation by a specialised paediatric retrieval team

Glasheen

Holmes

Rampersad

et al. 2019

Emerg Medicine Australasia

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Objectives Intubation of critically ill children is an infrequent procedure, and is associated with significant risk. We set out to describe intubations carried out by the Children's Health Queensland Retrieval Service (CHQRS), with the intention to identify areas for improvement in the performance of intubation in the retrieval setting. Methods Paediatric patients undergoing transport while intubated were identified, and cases where intubation occurred after the arrival of the CHQRS team were examined. Results Over the study period of January 2015 to September 2018, 498 intubated retrievals were undertaken; 85 patients were intubated after the arrival of CHQRS; the age range was 1 day to 16.5 years (median 0.5, interquartile range [IQR] 0.11–3 years). The median weight was 6.2 kg (IQR 3.7–16.5 kg). The pathology requiring intubation included respiratory 36 (42.3%), sepsis 21 (24.7%), neurological 11 (12.9%) and trauma 7 (8.2%). A total of 470 of 498 (94.4%) of intubated patients were from regional referral or tertiary hospitals, 28 of 498 (5.6%) were from rural and remote facilities. Of 85 patients, 57 (67.1%) were intubated by CHQRS and 28 (32.9%) were intubated by a doctor from the referring facility. The CHQRS team was more likely to perform the intubation in smaller children (median weight 5.0 vs 9.9 kg, P = 0.03). The mean scene time was 2.8 h. The scene time was shorter if the intubation was performed by CHQRS (mean 2.6 h, median 2.5, IQR 1.8–3.3; median 3, IQR 2.2–3.9; P = 0.048). The scene time was shorter when the intubation was predicted from tasking information (2.6 vs 3.1 h; P = 0.03). Conclusion Paediatric endotracheal intubation is an infrequent procedure in our service. An airway registry could improve documentation and gather information to identify specific training requirements and areas for practice improvement.

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“…This has been demonstrated in both pediatric and studies in adult patients. [21415161718] The additional crude mortality rates in critically ill children because of interfacility transport in developed countries are reported to be in the range of 4%–10%. [192021] We also found increased mortality and worsened SI as well as high serum lactate at admission in this group of children.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, most referrals do not take into account – weather conditions, time to transport, or availability of specialized equipment or personnel trained in pediatric transport. [2] Many countries including India have national ambulance service or emergency response system that are equipped with lifesaving equipments and can provide basic treatment to a patient before arrival in the hospital. [3] However, few patients/facilities are reported to use these services for various reasons.…”

Section: Introductionmentioning

confidence: 99%

Effect of prehospital transport factors on shock index, serum lactate, and mortality in children with septic shock: A prospective observational study

Sankar

Das

Singh

2019

J Emerg Trauma Shock

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Interhospital Transport of Critically Ill Children to PICUs in the United Kingdom and Republic of Ireland: Analysis of an International Dataset*

Abstract: Variations exist in United Kingdom and Ireland services for critically ill children needing interhospital transport. Future studies should assess the impact of these variations on long-term patient outcomes taking into account treatment provided prior to transport.

Cited by 32 publications

References 18 publications

Do infants with transposition of the great arteries born outside a specialist centre have different outcomes?

Do infants with transposition of the great arteries born outside a specialist centre have different outcomes?

Endotracheal intubation by a specialised paediatric retrieval team

Effect of prehospital transport factors on shock index, serum lactate, and mortality in children with septic shock: A prospective observational study

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