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Pediatric Interfacility Transport Modality and Outcomes

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      Background

      As pediatric facilities continue to coalesce and regionalize, regular access to pediatric specialty care becomes more difficult. This necessitates pediatric interfacility transport (pIFT) which can vary in modality between regular ground transport, CCT ground, rotor and fixed-wing. The literature is sparse regarding these pIFTs, how modality varies and their associated outcomes.

      Objective

      To examine the relationship between transport modality and outcomes for pediatric interfacility transports.

      Methods

      This was a retrospective cohort study. Regional transport records were matched with the National EMS Information System (NEMSIS) to identify pediatric (<18yo) interfacility transports to a regional quaternary children's hospital between Feb 2019-Feb 2020. The local EMR was then queried for clinical characteristics as well as outcomes data. Outcome measures included 72-hour mortality, 30-day mortality, length of stay and indicators of escalation of care (EoC). Statistics including regression analyses were performed in R.

      Results

      Outcomes data was collected for 540 of the 6181 total interfacility transports during the study period. Patient demographics showed 57% male, average age of 4.3 years and the majority were white race. 195 (36%) were ground, 207 (38%) were CCT ground, 75 (14%) were rotor-wing and the remaining 63 (12%) as fixed-wing. Segregating by modality, the shortest was ground transport with an average total duration of 107 minutes (range 36-330) compared to fixed-wing (396 mins, range 144-1991). 52% of all transports went to the ED. A general increase in initial patient acuity was seen as the transport modality escalated: ground transport (1% considered “critical”), CCT ground (74%), fixed-wing (68%) and rotor-wing (88%). Rotor-wing was also associated with the greatest number of age-adjusted abnormal vital signs upon arrival and therefore the aggregated risk score. There were 7 deaths in the first 72 hours and 12 deaths noted in the 30 days since admission. All deaths occurred in patients utilizing critical care transport. Median LOS was 72 hours across all modalities except ground (39 hours). 85% of rotor-wing transports required ICU level care in the first 72 hours as compared to 16% with ground transports. Aggregate EoC scores were worse with rotor-wing IFTs. Multivariate logistic regression did not show association between transport modality and mortality. Modality was only weakly associated with LOS and the aggregate EoC score (p <0.01, aR2 = 0.13). Variables that did show statistical association with outcomes measures included time at beside prior to transport, total risk score, trauma, initial acuity and initial hospital service (p<0.05).

      Conclusion

      While there were differences in patient demographics, clinical acuity and transport metrics across various forms of pITF, transport modality alone did not explain differences in 72-hour or 30-day mortality. There was only weak statistical association with hospital LOS and EoC. Future work remains to explore the complexities of pediatric interfacility transport and outcomes.
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