Transport Disposition Using the Transport Risk Assessment in Pediatrics (TRAP) Score

Abstract

Background Determining appropriate disposition for referred pediatric patients is difficult since it relies primarily on a telephone description of the patient. In this study, we evaluate the Transport Risk Assessment in Pediatrics (TRAP) score’s ability to assist in appropriate placement of these patients. This novel tool is derived from physiologic variables. Objectives To determine the feasibility of calculating a TRAP score and whether a higher score correlates with Pediatric Intensive Care Unit (PICU) admission. Methods We performed an observational study of pediatric patients transported by a specialized team to a tertiary care center and the feasibility of implementing the TRAP tool. Patients were eligible if transported by the pediatric specialty transport team for direct admission to the children’s hospital. The TRAP score was obtained either through chart review of transport team’s initial assessment or real-team by the transport team. Results A total of 269 patients were identified with 238 patients included in the study Using logistic regression, higher TRAP scores were associated with PICU admission (OR 1.40, p <0.001). Patients with a higher score were also less likely to leave the PICU within 24 hours (OR 0.79, p <0.001). Conclusion The TRAP score is a novel objective pediatric transport assessment tool where an elevated score is associated with PICU admission for greater than 24 hours. This score may assist with the triage decisions for transported pediatric patients.

Noninvasive ventilation for pediatric interfacility transports: a retrospective study

“…Children with a prior advanced care directive or tracheostomy were excluded. Baseline patient demographics and transport metrics included season of transport, distance and time of return leg (transport team departure to PICU admission), transport team assessment, Transport Risk Assessment in Pediatrics (TRAP) score [11], PICU arrival TRAP score, mode of ventilatory support, highest ventilatory support, highest fraction of inhaled oxygen (FiO 2 ), and need for sedation. Data on HFNC were also collected but analyzed separately from NIV.…”

The effect of care provided by paediatric critical care transport teams on mortality of children transported to paediatric intensive care units in England and Wales: a retrospective cohort study

“…they do not vary their team composition in individual cases based on the child’s acuity, other than to add a Consultant for sicker cases); however, at a service level, the standard team composition varies depending on whether ANPs and trained Junior Doctors (fellow) are available to staff the team [ 7 ]. Outside England and Wales, transport triage scores have been used, mostly to decide whether a physician should accompany the transport team based on the predicted need for interventions, although the evidence base for this approach is weak [ 12 , 13 ]. Evidence from neonatal transport suggests that ANP-led or Junior Doctor-led transports have similar patient outcomes [ 14 , 15 ].…”

Current Perspectives on Transport Medicine in Pediatric Hospital Medicine Fellowships

“…In addition, fellows could engage in clinical research and quality improvement projects related to TM given the overall paucity of literature in the field. 13 Several reasons can explain why fellows and graduates place a greater value on a TM rotation than PDs. Fellows and graduates may perceive inherent value in gaining particular knowledge and skills, such as greater understanding of the logistics and personnel involved in transferring patients and experience working with a healthcare team in a unique and dynamic setting.…”