Pediatric Specialized Transport Teams Are Associated With Improved Outcomes

Orr, Richard A.; Felmet, Kathryn; Han, Yong; McCloskey, Karin A.; Dragotta, Michelle; Bills, Debra M.; Kuch, Bradley A.; Watson, R. Scott

doi:10.1542/peds.2008-0515

Cited by 216 publications

(124 citation statements)

References 21 publications

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“…During transport by ambulance, we haven't any special team for transport and this carry a lot of risk during that journey. Orr et al, [31] in their study signify the importance of the transport team as a major factor in the outcome of cases and show that the mortality rate among patients transported by non specialized teams was more than among patients transported by specialized team for transport (23% versus 9%). Thirdly, inefficient standard of care.…”

Section: Results:-mentioning

confidence: 95%

Usefulness of the Pediatric Index of Mortality 2 in Predicting Mortality Rate in Benha University Pediatric Intensive Care Unit.

Elghaiaty¹,

Sobeih²,

Bayoumy³

2018

IJAR

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Background: little is known about the exact causes of death, and the impact of general risk factors that may complicate the course of critically ill patients. Scoring systems for use in ICUS allow an assessment. Aim of the study: To evaluate the usefulness of PIM2 score in predicting the outcome (mortality rate) in PICU in Benha university hospitals. Methods: This prospective study was conducted on 113 patients admitted to PICU in Benha University Hospitals in pediatric department over a period of six months. All patients aged more than one month up to less than sixteen years old. Pediatric index of mortality 2 was scored for all patients within an hour of admission to PICU using a structured data collection form and then compared with outcome which recorded as death or discharge. Results: Data were collected prospectively as a cohort study upon 11 children admitted to PICU in Benha University hospitals during a six months period. The outcome of the 113 patients included in the study was 77 survivors and 36 non-survivors. Observed death rate was (31.9%) and the predicted mortality rate by PIM2 score was 38.1%. So, the standardized mortality ratio was 0.84 signifying overestimation of mortality rate and/or good performance of our unit. PIM2 discriminated between death and survival well with area under the ROC curve was 0.73 and cutoff value at (-2.99) which is a good discrimination and calibrated well (p = 0.88 in non survivors and 0.83 in survivors). Conclusion: PIM2 applied in our PICU was significantly correlated to mortalities as PICU outcome and showed adequate discriminatory function and well calibrated for the case mix of patients in PICU of Benha University hospitals. So, it can be used as a good predictor of mortality in PICUS.

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Section: Results:-mentioning

confidence: 95%

Usefulness of the Pediatric Index of Mortality 2 in Predicting Mortality Rate in Benha University Pediatric Intensive Care Unit.

Elghaiaty¹,

Sobeih²,

Bayoumy³

2018

IJAR

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“…En este marco, la regionalización del cuidado de los RN que requieren cuidado intensivo y la optimización de la asistencia durante el traslado constituyen estrategias claves para mejorar los resultados de salud neonatal en nuestro país; a su vez, la constitución de equipos entrenados integrados por médicos y enfermeras, que estandaricen los procedimientos resulta prioritaria, ya que esta estrategia ha demostrado optimizar los resultados en el traslado de niños y RN en situación crítica en otros centros del mundo. [20][21][22] Resulta importante optimizar el cuidado neonatal durante el traslado, aun en los aspectos más sencillos, pero fundamentales, como la adecuada termorregulación y el manejo de la glucemia. El uso de herramientas o puntaje que miden sistemáticamente la calidad del traslado permite auditar y optimizar las condiciones de cuidado, lo cual favorece la seguridad y la eficiencia del cuidado neonatal.…”

Section: Discussionunclassified

Factores de riesgo asociados a deterioro clínico en el traslado de recién nacidos enfermos

et al. 2012

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Arch Argent Pediatr 2012;110(4):304-310 / 304 RESUMEN El traslado neonatal adecuado es clave en el cuidado de recién nacidos (RN) que requieren derivación. Objetivo. Determinar las características y el riesgo de deterioro clínico (DC) durante el traslado neonatal. Material y métodos. Estudio observacional y prospectivo; se incluyeron en forma consecutiva RN derivados a la UCIN del Hospital Garrahan. Se midió el puntaje TRIPS (Transport Risk Index of Physiology Stability) antes del traslado y después de él. Se consideró DC del RN cuando el TRIPS postraslado era mayor que el pretraslado. Se registraron características del RN, tipo de enfermedad, distancia, condición al ingreso, necesidad de soporte cardiorrespiratorio inmediato (SCRI) y óbito antes del 7° día y al alta. Se empleó análisis bivariado y multivariado para buscar asociaciones con el DC. Resultados. Se evaluaron 160 RN (EG 35 ± 3 sem, PN 2482 ± 904 g) con una mediana de 2 días de edad, derivados por enfermedades cardiorrespiratorias (50%) y quirúrgicas (34%) en su mayoría. En 57% (91) se observó DC; 46% presentó hipotermia. Requirieron SCRI 49 RN, 28 fallecieron (12 antes del 7º día de ingreso). Las variables estudiadas no se asociaron con el riesgo de DC. La mortalidad fue mayor en el grupo con DC (OR: 3,34 IC 95%: 1,2-8,7), aún luego de considerar la gravedad del RN (OR A : 3 IC 95%: 1,2-8,3). El DC se asoció con necesidad de SCRI (OR: 2,4 IC 95%: 1,2-5). Conclusiones. Los RN trasladados sufren con frecuencia pérdida de estabilidad o deterioro clí-nico independientemente de sus características; esto se relaciona con mayor mortalidad. Resulta imprescindible que se optimicen las estrategias de cuidado en todos los traslados neonatales. Clinical deterioration (CD) was considered when TRIPS value at admission was higher than the prior transportation value. We registered: diagnosis, distance, admission condition, immediate cardiorespiratory support (ICRS) requirement, and death before 7 th day, and at discharge. Associations with CD we evaluated by bivariate and multivariate analysis. Results. A total of 160 transferred NB were enrolled (GA: 35 ± 3 w, BW: 2482 ± 904 g), median 2 days, mostly due to cardiorespiratory (50%) or surgical (34%) illness. CD was observed; in 57% of the cases (91) furthermore, 46% presented hypothermia. Forty nine NB required ICRS, 28 died (12 before 7 th day). Studied variables were not associated with risk of CD. Mortality was higher in the deterioration group (24%) (OR 3,34; IC 95% 1,2-8,7), also when were considered NB risk (OR A 3; IC 95% 1,2-8,3). Clinical deterioration during transportation was associated with SCRI (OR 2,4; IC 95% 1,2-5). Conclusions. Transferred NB often loose stability or has CD, independently of their characteristics, and this is related to higher mortality. It is necessary to optimize care strategies during every neonatal transfer. INTRODUCCIÓNEl traslado neonatal adecuado es un componente clave del cuidado del recién nacido (RN) enfermo que requiere derivación a centros de mayor complejidad. Cuando un...

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“…Orr's seminal paper in 2009 added weight to earlier work that specialised teams must be used for transport [5]. In this large study, mortality rates in non-specialised teams were 23% compared to 9% after adjusting for illness severity.…”

Section: Introductionmentioning

confidence: 89%

Establishing a Combined Neonatal and Paediatric Transport System From Scratch

Hancock

Harrison²

2018

Curr Treat Options Peds

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Purpose of review Centralisation of neonatal and paediatric intensive care over the last 30 years has led to a significant increase in the numbers of newborn babies and children requiring interfacility transport. Many early ad hoc transport teams have evolved into specialised services providing mobile ICUs capable of providing state of the art critical care. This paper focuses on the development of combined neonatal and paediatric transport teams which has been driven by a pragmatic analysis of the benefits flowing from critical mass, economics and clinical cross fertilisation. Recent findings There is a growing body of evidence that specialist transport teams have better outcomes in terms of morbidity and mortality; however, anecdotal evidence would suggest that the benefits of a combined team are somewhat counterbalanced by the significant challenges of the wide scope of care and logistical complexity. Summary Establishing a combined service requires vision, time, hard work and support from the clinical and health care commissioning communities. Success of the project will depend on strong clinical leadership, a dedicated highly skilled group of professionals who share the vision, financial support and a foundation based on quality and safety. Given the high risk nature of the activity, any new service will need to benchmark against recognised standards and key performance metrics to ensure the best care possible is provided to this most vulnerable group of patients.

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Pediatric Specialized Transport Teams Are Associated With Improved Outcomes

Abstract: Transport of critically ill children to a pediatric tertiary care center can be conducted more safely with a pediatric critical care specialized team than with teams lacking specific training and expertise in pediatric critical care and pediatric transport medicine.

Cited by 216 publications

References 21 publications

Usefulness of the Pediatric Index of Mortality 2 in Predicting Mortality Rate in Benha University Pediatric Intensive Care Unit.

Usefulness of the Pediatric Index of Mortality 2 in Predicting Mortality Rate in Benha University Pediatric Intensive Care Unit.

Factores de riesgo asociados a deterioro clínico en el traslado de recién nacidos enfermos

Establishing a Combined Neonatal and Paediatric Transport System From Scratch

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