The effect of care provided by paediatric critical care transport teams on mortality of children transported to paediatric intensive care units in England and Wales: a retrospective cohort study

Sarah E Seaton, Elizabeth S Draper, Christina Pagel, Fatemah Rajah, Jo Wray, Padmanabhan Ramnarayan, DEPICT Study Team, Victoria Barber, Robert Darnell, Patrick Davies, Laura Drikite, Matthew Entwistle, Ruth Evans, Emma Hudson, Enoch Kung, Will Marriage, Stephen Morris, Paul Mouncey, Anna Pearce, Eithne Polke, Elizabeth S Draper, Christina Pagel, Fatemah Rajah, Padmanabhan Ramnarayan, Sarah E Seaton, Jo Wray, Sarah E Seaton, Elizabeth S Draper, Christina Pagel, Fatemah Rajah, Jo Wray, Padmanabhan Ramnarayan, DEPICT Study Team, Victoria Barber, Robert Darnell, Patrick Davies, Laura Drikite, Matthew Entwistle, Ruth Evans, Emma Hudson, Enoch Kung, Will Marriage, Stephen Morris, Paul Mouncey, Anna Pearce, Eithne Polke, Elizabeth S Draper, Christina Pagel, Fatemah Rajah, Padmanabhan Ramnarayan, Sarah E Seaton, Jo Wray

Abstract

Background: Centralisation of paediatric intensive care units (PICUs) has the increased the need for specialist paediatric critical care transport teams (PCCT) to transport critically ill children to PICU. We investigated the impact of care provided by PCCTs for children on mortality and other clinically important outcomes.

Methods: We analysed linked national data from the Paediatric Intensive Care Audit Network (PICANet) from children admitted to PICUs in England and Wales (2014-2016) to assess the impact of who led the child's transport, whether prolonged stabilisation by the PCCT was detrimental and the impact of critical incidents during transport on patient outcome. We used logistic regression models to estimate the adjusted odds and probability of mortality within 30 days of admission to PICU (primary outcome) and negative binomial models to investigate length of stay (LOS) and length of invasive ventilation (LOV).

Results: The study included 9112 children transported to PICU. The most common diagnosis was respiratory problems; junior doctors led the PCCT in just over half of all transports; and the 30-day mortality was 7.1%. Transports led by Advanced Nurse Practitioners and Junior Doctors had similar outcomes (adjusted mortality ANP: 0.035 versus Junior Doctor: 0.038). Prolonged stabilisation by the PCCT was possibly associated with increased mortality (0.059, 95% CI: 0.040 to 0.079 versus short stabilisation 0.044, 95% CI: 0.039 to 0.048). Critical incidents involving the child increased the adjusted odds of mortality within 30 days (odds ratio: 3.07).

Conclusions: Variations in team composition between PCCTs appear to have little effect on patient outcomes. We believe differences in stabilisation approaches are due to residual confounding. Our finding that critical incidents were associated with worse outcomes indicates that safety during critical care transport is an important area for future quality improvement work.

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

Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
Grade of the team leader of the transport and adjusted mortality within 30 days of admission to PICU. Adjusted probabilities are estimated whilst holding other covariates at their average value. Adjustments were made for: time taken to reach the bedside of the child; age of child; PIM 2 score; diagnosis of the child; whether they were ventilated at the time of referral and whether they were receiving critical care
Fig. 2
Fig. 2
Unadjusted and adjusted mortality by the percentage of interventions delivered whilst the PCCT were present and in total. Adjusted probabilities are estimated whilst holding other covariates at their average value. Adjustments were made for: time taken to reach the bedside of the child; age of child; PIM 2 score; diagnosis of the child; whether they were ventilated at the time of referral and whether they were receiving critical care

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