Outcomes of Pediatric Patients in Secondary Transport to Tertiary Hospital: A Retrospective Observational Study.
Journal
Pediatric emergency care
ISSN: 1535-1815
Titre abrégé: Pediatr Emerg Care
Pays: United States
ID NLM: 8507560
Informations de publication
Date de publication:
01 Jun 2022
01 Jun 2022
Historique:
pubmed:
19
4
2022
medline:
3
6
2022
entrez:
18
4
2022
Statut:
ppublish
Résumé
Emergency medical service (EMS) providers play an important role in determining which hospital to choose. To date, there is no evidence-based guideline to support their decisions, except for major trauma cases. Secondary transport is considered when a patient needs further investigation or treatment after primary transport, but this can delay treatment and put patients at unnecessary risk. The objective of this study was to investigate the outcomes of pediatric secondary transport patients to tertiary hospitals. This was a citywide population-based observational study conducted in Kobe, Japan. We reviewed the EMS registry to identify secondary transport patients younger than 19 years and investigated their clinical characteristics. We excluded cases of unknown hospital destinations, nontransported cases, and major trauma patients who followed a different protocol for a hospital destination. The primary endpoint was the hospital outcome 12 hours after transport. Because there was no link between the EMS patient transport data and the hospital medical records, a probabilistic linkage was performed to obtain the hospital outcomes. Patients who required secondary transport were compared with patients transported directly to tertiary hospitals. A total of 13,720 pediatric patients were transported from the field by Kobe EMS between January 2013 and December 2015. Among them, 81 pediatric patients (0.6%) required secondary transport to tertiary hospitals within 24 hours of the primary transport, whereas a total of 3673 patients (27%) were transported directly to tertiary hospitals. Despite no apparent difference in prehospital severity, secondary transport patients were associated with higher hospitalization rates and a need for critical care compared with those who had direct transport. Seizure was the most common reason for the use of secondary transport, and 89% of the seizure patients were hospitalized after undergoing secondary transport; minor trauma was the second most common reason for the use of secondary transport, and 53% of the patients were hospitalized. In this study, the characteristics of the secondary transport patients and hospital outcomes revealed a heterogeneity in pediatric prehospital transport. It is recommended that the development of pediatric EMS destination guidelines cover children's diverse conditions. Further studies are required, and linkages between prehospital and hospital data will help promote a better understanding of appropriate hospital destinations.
Identifiants
pubmed: 35436767
doi: 10.1097/PEC.0000000000002711
pii: 00006565-202206000-00008
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
283-289Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure: The authors declare no conflict of interest.
Références
McManus K, Finlay E, Palmer S, et al. A statewide analysis of EMS' pediatric transport destination decisions. Prehosp Emerg Care . 2020;24:672–682.
Kloot K, Salzman S, Kilpatrick S, et al. Initial destination hospital of paediatric prehospital patients in rural Victoria. Emerg Med Australas . 2016;28:205–210.
Richard J, Osmond MH, Nesbitt L, et al. Management and outcomes of pediatric patients transported by emergency medical services in a Canadian prehospital system. CJEM . 2006;8:6–12.
Drayna PC, Browne LR, Guse CE, et al. Prehospital pediatric care: opportunities for training, treatment, and research. Prehosp Emerg Care . 2015;19:441–447.
Houtekie L, Meert P, Thys F, et al. Prehospital paediatric emergencies in Belgium: an epidemiologic study. Eur J Emerg Med . 2015;22:107–110.
Diggs LA, Sheth-Chandra M, De Leo G. Epidemiology of pediatric prehospital basic life support care in the United States. Prehosp Emerg Care . 2016;20:230–238.
Harve H, Salmi H, Rahiala E, et al. Out-of-hospital paediatric emergencies: a prospective, population-based study. Acta Anaesthesiol Scand . 2016;60:360–369.
Andersen K, Mikkelsen S, Jørgensen G, et al. Paediatric medical emergency calls to a Danish emergency medical dispatch centre: a retrospective, observational study. Scand J Trauma Resusc Emerg Med . 2018;26:2.
Lerner EB, Dayan PS, Brown K, et al. Characteristics of the pediatric patients treated by the Pediatric Emergency Care Applied Research Network's affiliated EMS agencies. Prehosp Emerg Care . 2014;18:52–59.
Fratta KA, Fishe JN. EMS, pediatric transport safety and secondary transport. StatPearls [Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK513234/ . Accessed January 11, 2020.
Fratta KA, Fishe JN, Anders PD, et al. Improving EMS destination choice for pediatrics: results of a novel pediatric destination decision tool pilot test. Am J Emerg Med . 2020;46:769–771.
Gray A, Bush S, Whiteley S. Secondary transport of the critically ill and injured adult. Emerg Med J . 2004;21:281–285.
Orr RA, Felmet KA, Han Y, et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics . 2009;124:40–48.
Mohr NM, Harland KK, Shane DM, et al. Potentially avoidable pediatric interfacility transfer is a costly burden for rural families: a cohort study. Acad Emerg Med . 2016;23:885–894.
Hegenberg K, Trentzsch H, Pruckner S. Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport. BMJ Open . 2019;9:e030636.
Adelgais KM, Hansen M, Lerner EB, et al; Members of the SAEM Consensus Conference Emergency Medical Services Subcommittee. Establishing the key outcomes for pediatric emergency medical services research. Acad Emerg Med . 2018;25:1345–1354.
Report of Emergency Transport Severity and Urgency Judgment Criteria Development Committee (in Japanese). Available at: http://www.fasd.or.jp/tyousa/hanso01.pdf . Accessed January 11, 2020.
Bonafide CP, Localio AR, Roberts KE, et al. Impact of rapid response system implementation on critical deterioration events in children. JAMA Pediatr . 2014;168:25–33.
Fishe JN, Psoter KJ, Klein BL, et al. Retrospective evaluation of risk factors for pediatric secondary transport. Prehosp Emerg Care . 2018;22:41–49.
Brodsky R, Merlin MA, Leva EG, et al. Do all pediatric patients who have a febrile seizure require transport by advanced life support? Pediatr Emerg Care . 2009;25:317–320.
Salmi H, Oulasvirta J, Rahiala E, et al. Out-of-hospital seizures in children: a population-based study [published online January 22, 2020]. Pediatr Emerg Care . 2020. doi:10.1097/PEC.0000000000002001.
doi: 10.1097/PEC.0000000000002001
Abramson TM, Rose E, Crow E, et al. Paramedic identification of pediatric seizures: a prospective cohort study. Prehosp Emerg Care . 2020;25:682–688.
Li J, Monuteaux MC, Bachur RG. Interfacility transfers of noncritically ill children to academic pediatric emergency departments. Pediatrics . 2012;130:83–92.
Leroux Y, Cook J, Goldstein J, et al. Pediatric secondary transfer percentages: a retrospective observational study. Cureus . 2020;12:e6766.
Odetola FO, Clark SJ, Gurney JG, et al. Effect of interhospital transfer on resource utilization and outcomes at a tertiary pediatric intensive care unit. J Crit Care . 2009;24:379–386.
Cook SH, Fielding JR, Phillips JD. Repeat abdominal computed tomography scans after pediatric blunt abdominal trauma: missed injuries, extra costs, and unnecessary radiation exposure. J Pediatr Surg . 2010;45:2019–2024.
Fishe JN, Psoter KJ, Anders JF. Emergency medical services bypass of the closest facility for pediatric patients. Prehosp Emerg Care . 2019;23:485–490.
Bible JE, Kadakia RJ, Kay HF, et al. How often are interfacility transfers of spine injury patients truly necessary? Spine J . 2014;14:2877–2884.