The effect of patient geography on hospital length of stay in critically ill pediatric patients.
CCCF ePoster library. Sample M. Oct 2, 2017; 198118; 25
Megan Sample
Megan Sample
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The effect of patient geography on hospital length of stay in critically ill pediatric patients.

Sample, Megan1,2; Acharya, Anand3; O’Hearn, Katie4; Livingstone, Shane5; Menon, Kusum1,2

1-Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada

2-Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada

3-
Department of Economics, Carleton University

4-Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada

5-Planning division, Government Operations Centre, Ottawa, Ontario, Canada


Introduction: Canada is comprised of a vast geographic area and as such, there are a significant number of children who live in areas where there is no direct access to specialized pediatric critical care services. Distance from a tertiary care PICU and patient transport have been suggested to increase use of PICU resources and affect survival1,2.
 
Objectives: Our objective was to explore the effect of living in rural areas and requiring transport to access pediatric ICU services on clinically important outcomes of critically ill children in Ontario, Southwestern Quebec and Nunavut.
 
Methods: Data was collected on all patients admitted to the PICU at CHEO from February 1st, 2015 to January 31st, 2016. Admission and discharge dates, interventions used, illness severity, mortality and transport data were recorded.
 
Results: There were 524 PICU admissions involving 455 unique patients of whom 169 were transported from another centre. Admission PRISM score (4, IQR: 1, 8 versus 2, IQR: 0, 5; P = 0.001), rate of mechanical ventilation (58.6% versus 39.2%; P < 0.001) and mortality rate (7.1% versus 0.4%; P < 0.001) were significantly higher for transported versus non-transported patients. For transported patients, transport by land (OR 1.82, P = 0.002), duration of transport (HR 1.15, P = 0.001) and admission PRISM (HR 1.10, P < 0.001) were all associated with increased PICU length of stay (Table 1). The odds of death increased with transport by land, duration of transport and PRISM score (Table 2). The mode of transport from referral centers is represented in Figure 1. Neither distance travelled or home population size had a significant effect on PICU length of stay or mortality.
 
Conclusion: Transported patients had a higher PICU mortality rate than those who presented directly to a tertiary care centre. In patients transported from other centres, longer duration of transport and transport by land were associated with higher mortality rates, PRISM scores and increased PICU length of stay. Further research to explain these findings is warranted.
 

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