Epidemiology of Pediatric Critical Care Transport in Northern Alberta and the Western Arctic

• Published in: Pediatric Critical Care Medicine
• Main Authors: Kawaguchi, Atsushi, Nielsen, Charlene C., G. Guerra, Gonzalo, Saunders, L. Duncan, Yasui, Yutaka, DeCaen, Allan
• Format: Article in Journal/Newspaper
• Language: English
• Published: Ovid Technologies (Wolters Kluwer Health) 2018
• Subjects: Arctic; Canada
• Online Access: http://dx.doi.org/10.1097/pcc.0000000000001491; https://journals.lww.com/00130478-201806000-00025

Objective: Specialized pediatric critical care transport teams are essential to pediatric retrieval systems. This study aims to describe the contemporary transports performed by a Canadian pediatric critical care transport team and to compare the treatment and outcomes of children referred from high-level care (hospitals offering pediatric services where an adult ICU exists) and nonhigh-level care (all other hospitals) hospitals. Design: A descriptive cohort study. Setting: The Stollery Children’s Hospital in Edmonton, Alberta, Western Canada. Patients: Children younger than 17 years old transported by the transport team from referral hospitals within the Stollery Children’s Hospital catchment area to Stollery Children’s Hospital between 1998 and 2015. Interventions: None. Measurements and Main Results: Characteristics of transports, patient demographics presenting vital signs, and outcomes were described overall and compared by transport-related time and referral hospital types (high-level care and nonhigh-level care). In total, 3,352 transports met the inclusion criteria; 1,049 were retrieved from eight high-level care hospitals and 2,303 from 53 nonhigh-level care hospitals; the median one-way transport distance was 383 kilometers, and 70% of the transports were air transports. The annual number of transports has increased during the study period. The PICU admission rate was between 40% and 55%. Transports from high-level care hospitals had significantly higher odds of being admitted to the PICU (odds ratio, 1.96; 95% CI, 1.31–2.93). The odds of intubation at the referral hospital were higher in the high-level care group, but the odds of intubation upon PICU admission was similar between the two groups. Mortality during or after transport was not significantly different between high-level care and nonhigh-level care hospitals. Conclusions: The current transport system has multiple priorities with regard to efficiency and quality. The medical services at referral hospitals may affect the likelihood of PICU ...