Paediatric health care access in community health centres is associated with survival for critically ill children who undergo inter-facility transport: A province-wide observational study. Issue 5 (26th April 2019)

• Record Type: Journal Article
• Authors: Tijssen, Janice A; To, Teresa; Morrison, Laurie J; Alnaji, Fuad; MacDonald, Russell D; Cupido, Cynthia; Lee, Kyong-Soon; Parshuram, Christopher S
• Is Part Of: Paediatrics & Child Health. Volume 25:Issue 5(2020)
• Page Start: 308
• Page End: 316
• Publication Date: 2019-04-26
• Subjects: Critical care -- Critical illness -- Intensive care units (paediatric) -- Outcome assessment (health care) -- Resource allocation -- Referral and consultation; Pediatrics -- Periodicals; Children -- Health and hygiene -- Periodicals; 618.92
• DOI: 10.1093/pch/pxz013
• Languages: English
• ISSNs: 1205-7088

Abstract

Abstract: Background: Diverse settlement makes inter-facility transport of critically ill children a necessary part of regionalized health care. There are few studies of outcomes and health care services use of this growing population. Methods: A retrospective study evaluated the frequency of transports, health care services use, and outcomes of all critically ill children who underwent inter-facility transport to a paediatric intensive care unit (PICU) in Ontario from 2004 to 2012. The primary outcome was PICU mortality. Secondary outcomes were 24-hour and 6-month mortality, PICU and hospital lengths of stay, and use of therapies in the PICU. Results: The 4, 074 inter-facility transports were for children aged median (IQR) 1.6 (0.1 to 8.3) years. The rate of transports increased from 15 to 23 per 100, 000 children. There were 233 (5.7%) deaths in PICU and an additional 78 deaths (1.9%) by 6 months. Length of stay was median (IQR) 2 (1 to 5) days in PICU and 7 (3 to 14) days in the receiving hospital. Lower PICU mortality was independently associated with prior acute care contact (odds ratio [OR]=0.3, 95% confidence interval [CI]: 0.2 to 0.6) and availability of paediatric expertise at the referral hospital (OR=0.7, 95% CI: 0.5 to 1.0). Conclusions: We found that in Ontario, children undergoing inter-facility transport to PICUs are increasing in number, consume significant acute care resources, and have a high PICU mortality. Access to paediatric expertise is a potentially modifiable factor that can impact mortality and warrants further evaluation.