Publication Date

4-2022

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Abstract

Abstract Objectives: Appropriate triage and disposition during transport can reduce the need for unplanned transfers to the pediatric intensive care unit (PICU) within 24 hours of admission. The pediatric early warning score (PEWS) is utilized to monitor for inpatient clinical deterioration and acuity during transport at our hospital. We sought to determine predictive factors of patients admitted to the inpatient ward who required PICU transfer within 24 hours following transport by Children’s Mercy Critical Care Transport (CMCCT) team. We hypothesized patients with respiratory illness and PEWS > 4 during interfacility transport are at higher risk of PICU transfer within 24 hours of admission. Methods: A retrospective, case-controlled chart review of 100 total transports by CMCCT between January 2018 - December 2020 was performed. We included patients 1 month to 18 years of age admitted to the inpatient ward with respiratory illness and excluded patients with congenital heart disease. PICU transfers within 24 hours were compared to the control group who did not require PICU transfer. Metrics from pre-transport, transport, floor and first 24 hours after PICU transfer were recorded into the Research Electronic Data Capture Database (REDCap). Results: PICU transfers had a median PEWS score of 4 [3,5, p= 0.036] compared to a PEWS of 3 [2,4, p= 0.036] in patients who remained on the floor. PEWS scores were grouped into green (0-2), yellow (3) and red zone ( > 4) based on our institutional floor protocol for multivariate analysis. A trend towards higher transport PEWS scores for PICU transfers within 24 hours was noted with 30/50 (OR 2.02, p= 0.141) having the highest transport PEWS in the red zone as compared to the control group but was not statistically significant. A trend towards higher admission PEWS for PICU transfers was also noted. A higher floor admission PEWS in the red zone was statistically significant for PICU transfer with 23/50 (OR 4.95, p= 0.001). There were no differences between the 2 groups related to prematurity (p= 0.795), home oxygen (p= 0.999), high flow nasal cannula (p= 0.262), or continuous beta agonist (p= 0.454). Patients transferred to the PICU did have lower weights (11.7, [7.8, 17.7], p= 0.09) compared to those who remained on the floor (median 14.7, [IQR 10.3,20.1], p = 0.09), however, this was not statistically significant. Conclusion: Our analysis showed a trend towards higher transport PEWS for patients who required subsequent PICU transfer but was not statistically significant, suggesting PEWS alone may not be a useful scoring tool to determine patient disposition during transport. A higher PEWS score after hospital admission on the general pediatric floor was associated with PICU transfer. Future directions should include additional study with larger sample sizes analyzing other risk factors or interventions during interfacility transport that might predict PICU transfer after admission to the floor.

Disciplines

Critical Care | Pediatrics

Notes

Presented at the Critical Care Transport Medicine Conference; Orange Beach, AL; April 10-13, 2022.

Identifying Predictive Factors for Patients Transferred From Floor to PICU within 24 hours of Admission by a Pediatric Critical Care Transport Team

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