Epidemiology of Pediatric Critical Care Transport in Northern Alberta and Western Arctic
CCCF ePoster library. Kawaguchi A. Oct 3, 2017; 198105
Dr. Atsushi Kawaguchi
Dr. Atsushi Kawaguchi
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Abstract
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Epidemiology of Pediatric Critical Care Transport in Northern Alberta and Western Arctic

Atsushi Kawaguchi 1,2; Charlene Nielsen 2, 3; Duncan Saunders 2; Yutaka Yasui 2; Allan DeCaen 1

1 Department of Pediatrics, Pediatric Critical Care Medicine, University of Alberta, Edmonton, Canada

2 School of Public Health, University of Alberta, Edmonton, Canada

3 Department of Biological Science, Faculty of Science, University of Alberta, Edmonton, Canada


 



 

INTRODUCTION and OBJECTIVES
A specialized Pediatric Critical Care transport team (PICU transport team) has been based out of a Northern Alberta University-affiliated children’s hospital for the last 20 years, and has played a core role in Western Canada’s pediatric retrieval system. This study aims to characterize the contemporary transports performed by the PICU transport team, and explore the impact of medical services in referral hospitals in the retrieval system.
 
METHODS
A descriptive cohort study was conducted of PICU transports from referral hospitals to a single academic PICU between 1998 and 2015. By using tabulation and mappings,  demographics and characteristics of the transports are described. We then compared the patients’ outcomes (PICU admission, PICU and hospital length of stay, mortality, endotracheal intubation and invasive ventilation days) between the transports from the two hospital groups: (1) High-Level Care (HLC) hospitals (hospitals offering pediatric services where either adult ICU or PICU is available); and (2) Non-High-Level Care (NHLC) hospitals (all the other hospitals). Regression analyses with referral hospitals as random effects with propensity score adjustments were performed.
                             
RESULTS
In total, 3,352 transports met our inclusion criteria: 1,049 (31%) were retrieved from 8 HLC hospitals and 2,303 (69%) were from 53 NHLC hospitals (Figure1). The total number of transports has increased gradually throughout the study period and the catchment area has widened over the study period (Figure2).
The PICU admission rate was between 40-55%. More than 70% of the transports were air transports. The median transport distance was 382.9 kilometers. Transports from the HLC hospitals had significantly higher odds of being admitted to the PICU (OR: 1.96, 95%CI: 1.31 - 2.93, p=0.001). Mortality during or after the transports was not significantly different between the two groups. The odds of endotracheal intubation at the referral hospital were higher in the HLC group, but the risk of intubation upon PICU admission was similar between the two groups.
 
CONCLUSION
The current transport system has multiple priorities regarding efficiency and quality in the context of expanding the program. No negative impact was observed on PICU outcomes, in particular when comparing the level of medical services offered at referral hospitals.
 



 



 

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