MORBIDITY AND SEVERITY OF ILLNESS DURING INTERHOSPITAL TRANSFER - IMPACT OF A SPECIALIZED PEDIATRIC RETRIEVAL TEAM

Objective-To evaluate the morbidity and severity of illness during int erhospital transfer of critically ill children by a specialised paedia tric retrieval team. Design-Prospective, descriptive study. Setting-Ho spitals without paediatric intensive care facilities in and around the London area, and a paediatric intensive care unit at a tertiary centr e. Subjects-51 critically ill children transferred to the paediatric i ntensive care unit. Main outcome measures-Adverse events related to eq uipment and physiological deterioration during transfer. Paediatric ri sk of mortality score before and after retrieval. Therapeutic interven tion score before and after arrival of retrieval team. Results-Two (4% ) patients had preventable physiological deterioration during transpor t. There were no adverse events related to equipment. Severity of illn ess decreased during stabilisation and transport by the retrieval team , suggested by the difference between risk of mortality scores before and after retrieval (P < 0.001). The median (range) difference between the two scores was 3.0 (-6 to 17). Interventions during stabilisation by the retrieval team increased, demonstrated by the difference betwe en intervention scores before and after retrieval, median (range) diff erence between the two scores being 6 (-8 to 38) (P < 0.001). Conclusi ons-Our study indicates that a specialised paediatric retrieval team c an rapidly deliver intensive care to critically iu children awaiting t ransfer. Such children can be transferred to a paediatric intensive ca re unit with minimal morbidity and mortality related to transport. The re was no deterioration in the clinical condition of most patients dur ing transfer.