Does time taken by paediatric critical care transport teams to reach the bedside of critically ill children affect survival? A retrospective cohort study from England and Wales

Sarah E Seaton, Padmanabhan Ramnarayan, Patrick Davies, Emma Hudson, Stephen Morris, Christina Pagel, Fatemah Rajah, Jo Wray, Elizabeth S Draper, DEPICT Study Team, Sarah E Seaton, Padmanabhan Ramnarayan, Patrick Davies, Emma Hudson, Stephen Morris, Christina Pagel, Fatemah Rajah, Jo Wray, Elizabeth S Draper, DEPICT Study Team

Abstract

Background: Reaching the bedside of a critically ill child within three hours of agreeing the child requires intensive care is a key target for Paediatric Critical Care Transport teams (PCCTs) to achieve in the United Kingdom. Whilst timely access to specialist care is necessary for these children, it is unknown to what extent time taken for the PCCT to arrive at the bedside affects clinical outcome.

Methods: Data from transports of critically ill children who were admitted to Paediatric Intensive Care Units (PICUs) in England and Wales from 1 January 2014 to 31 December 2016 were extracted from the Paediatric Intensive Care Audit Network (PICANet) and linked with adult critical care data and Office for National Statistics mortality data. Logistic regression models, adjusted for pre-specified confounders, were fitted to investigate the impact of time-to-bedside on mortality within 30 days of admission and other key time points. Negative binomial models were used to investigate the impact of time-to-bedside on PICU length of stay and duration of invasive ventilation.

Results: There were 9116 children transported during the study period, and 645 (7.1%) died within 30 days of PICU admission. There was no evidence that 30-day mortality changed as time-to-bedside increased. A similar relationship was seen for mortality at other pre-selected time points. In children who waited longer for a team to arrive, there was limited evidence of a small increase in PICU length of stay (expected number of days increased from: 7.17 to 7.58).

Conclusion: There is no evidence that reducing the time-to-bedside target for PCCTs will improve the survival of critically ill children. A shorter time to bedside may be associated with a small reduction in PICU length of stay.

Keywords: Critical care transport; Paediatric intensive care; Paediatric transport.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flow chart for the primary analysis
Fig. 2
Fig. 2
Probability of mortality within 30 days of PICU admission by time taken to reach the bedside whilst holding other variables in the model at the mean value
Fig. 3
Fig. 3
Expected PICU length of stay and length of ventilation in PICU (days) by time taken to arrive at the bedside whilst holding other variables in the model at the mean value

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