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