Abstract
The likelihood of physiological deterioration or adverse events during the retrieval of critically ill children is reduced by dedicated paediatric transport teams. Recently the neonatal transport team based at the Hospital for Sick Children (HSC) has expanded its mandate to retrieve children up to 2 years of age. The Acute Care Transport Services (ACTS) team has translated its neonatal stabilization philosophy of “stay and play” into paediatric critical care transports. However other teams consider a “scoop and run” philosophy to be the most effective and safest means of transporting critically ill children.
To investigate if “stay and play” stabilization of critically ill children is associated with physiological deterioration or an increased likelihood of adverse events on transport.
Data was prospectively collected on all paediatric transports by ACTS from Nov 2002 to Nov 2003. Details recorded included patient demographics, referral problem, transport mobilization & stabilization times and adverse events during transport. A physiology score based on a modified PRISM score was used as an index of illness severity and recorded on arrival and following departure of the team from the referral hospital. The effectiveness of transport stabilization was assessed by comparing pre-and post-stabilization physiology scores. An intervention score was constructed to assess details of the stabilization process. The relationship between intervention scores and stabilization times was examined using linear regression methods.
35 children were retrieved during the study time-period. The average age at referral was 5.7 months (Range 1.5–24). The referring diagnosis included CNS disease (37%), respiratory failure (34%), septicaemic shock (14%), cardiac disease (8.6%) and others (6.4%). Patients were referred from an emergency department (60%) or paediatric ward (31.4%). The average mobilization and stabilization times for ACTS were 33.4 mins (Range 5–315) and 140 mins (Range 40–320) respectively. 94.3% patients demonstrated improvement or plateau in their physiology score with a significant reduction in physiologic score over the stabilization period from 4.17 to 2.88 (1.875 2.2, p=0.002). There was a positive relationship between the length of stabilization and the calculated intervention score (r=0.61, p<0.001). There were no critical incidents or adverse patient or equipment events during transport. 88.6% patients were admitted to the critical care unit at HSC.
This study demonstrates that the physiologic condition of critically ill children is improved and the likelihood of adverse events is reduced following aggressive stabilization by a dedicated “mobile ICU” team.
