CRITICAL CARE PEDIATRICIAN-LED AEROMEDICAL TRANSPORTS - PHYSICIAN INTERVENTIONS AND PREDICTIVENESS OF OUTCOME

This article reviews the one-year experience (March 28, 1987 to March 27, 1988) of the pediatric transport service of the University of Wisc onsin Hospital and Clinics (UWHC). The UWHC pediatric transport team c onsisted of a critical care flight nurse and a pediatric critical care attending physician or fellow. The aims of the study were to: 1) dete rmine the types and number of interventions performed by the physician s to gauge the need for physician presence on transport; and 2) determ ine which variables (severity of illness scores, age, gender, distance from hospital) recorded at the time of the referral telephone call be st predicted outcome of the patient. There were 109 children transport ed by helicopter during the one-year study period. Thirty percent of t he patients (43% of trauma patients and 22% of medical patients) had n o interventions at all, 18% of medical patients and 10% of trauma pati ents were intubated, and 9% of medical patients and no trauma patients had central venous catheters inserted. Multivariate modeling determin ed that among medical patients, outcome could be accurately predicted only 38% of the time if telephone PRISM (Pediatric Risk of Mortality) scores were determined. Among trauma patients, if gender, age, distanc e from UWHC, and telephone PRISM scores were known, outcome could be p redicted 74% of the time. Unless studies show the benefit of pediatric ian-accompanied transport, transports could probably be done without c ritical care pediatricians. Severity of illness scoring at this time i s probably not sufficiently accurate to warrant its use for deciding t he appropriateness of transport of pediatric patients.