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

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 admission and subsequent PICU length of stay; however, no negative impact was observed in other outcomes including mortality. Dr. Kawaguchi conceptualized and designed the study, conducted data collection and cleaned the data, carried out analysis, drafted the initial manuscript, revised the initial manuscript, and approved the final manuscript as submitted. Ms. Nielsen conducted spatial data analysis and other mapping procedures, reviewed and revised the original manuscript, and approved the final manuscript as submitted. Dr. Guerra helped to conceptualize the study, revised the initial manuscript, and approved the final manuscript as submitted. Dr. Saunders helped to conceptualize and design the study, helped with data analysis, reviewed and revised the initial manuscript, and approved the final manuscript as submitted. Dr. Yasui helped with data analysis, reviewed and revised the initial manuscript, and approved the final manuscript as submitted. Dr. DeCaen conceptualized and designed the study, revised the initial manuscript, and approved the final manuscript as submitted. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://ift.tt/2gIrZ5Y). Dr. Kawaguchi received funding from a Graduate Studentship Award from the Women and Children’s Health Research Institute and the Alberta Machine Intelligence Institute (to Drs. Saunders and Yasui). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: atsushi@ualberta.ca ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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