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Temperature Elevation During Neonatal and Pediatric Fixed Wing Transport in a Subtropic Climate: A Descriptive Study

  • Anthony A. Sochet
    Correspondence
    Address for correspondence: Anthony A. Sochet, MD, MHSc, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, 501 6th Ave S, Suite 702, St Petersburg, FL 33701.
    Affiliations
    Department of Medicine, Division of Pediatric Critical Care Medicine, Johns Hopkins All Children's Hospital, St Petersburg, FL

    Department of Anesthesiology and Critical Care, Division of Pediatric Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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  • Walter Miller
    Affiliations
    Department of Transport Medicine, Johns Hopkins All Children's Hospital, St Petersburg, FL
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  • Ladonna K. Bingham
    Affiliations
    Department of Anesthesiology and Critical Care, Division of Pediatric Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

    Department of Medicine, Divisions of Pediatric Critical Care Medicine and Transport Medicine, Johns Hopkins All Children's Hospital, St Petersburg, FL
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Published:October 22, 2020DOI:https://doi.org/10.1016/j.amj.2020.10.002

      Abstract

      Objective

      We sought to describe the degree of temperature elevation (∆T) among children transported in a subtropical climate (Florida) via fixed wing aircraft and identify potential relationships between patient weight and ∆T.

      Methods

      We performed a retrospective cohort study in children < 18 years of age undergoing interfacility transport via fixed wing aircraft from January 2016 through July 2020. The study outcomes were ∆T, maximum patient temperature, ambient temperature, and heat index. Bivariate cohorts defined by patient weight (5 kg) were compared using Fisher exact, Student t-, and Wilcoxon rank sum analyses. Exploratory testing included receiver operator characteristic curve analyses and unadjusted logistic regression.

      Results

      Of the 58 children studied, 25 (43%) were ≤ 5 kg, and 33 (57%) were > 5 kg. Compared with children > 5 kg, those ≤ 5 kg had greater ∆T (0.8° ± 0.6°C vs. 0.2° ± 0.3°C), maximum patient temperature (37.3° ± 0.6°C vs. 36.8° ± 0.4°C), and proportion with ≥ 1°C ∆T (36% vs. 3%). No child > 5 kg had a temperature > 38°C, and no differences were observed for heat index or ambient temperature. Receiver operating characteristic analysis of patient weight on ∆T ≥ 1°C yielded an area under the curve of 0.86 (cutoff of 3.5 kg; sensitivity = 81.3%, specificity = 80%). Patient weight was inversely associated with ∆T ≥ 1°C (odds ratio = 0.69; 95% confidence interval, 0.49-0.96).

      Conclusions

      Young children appear at greatest risk for developing environmental hyperthermia during interfacility fixed wing transport.
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