Allan Joseph, MD, MPH
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Christopher Horvat, MD, MHA
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Idris Evans, MD, MS
Assistant Professor
Children's Hospital of Pittsburgh of UPMC, United States
Disclosure information not submitted.
Bradley Kuch, MHA, RRT-NPS, FAARC
Director, Respiratory Care Services and Transport Team
UPMC Children's Hospital of Pittsburgh, United States
Disclosure information not submitted.
Jeremy Kahn, MD, MS
Vice Chair for Research, Department of Critical Care Medicine
University of Pittsburgh, United States
Disclosure information not submitted.
Title: Association Between Mode of Interfacility Transport and Outcomes Among Critically Ill Children
INTRODUCTION/HYPOTHESIS:
Critically ill children require timely transfer to a specialized pediatric care center via either helicopter or ground transport. Whether or not mode of transfer influences clinical outcomes remains unclear. We hypothesized that among critically ill patients transferred to a pediatric hospital via a specialized pediatric transport team, helicopter transfer will be associated with shorter transport times but similar clinical outcomes compared to ground transfer.
Methods:
We performed a retrospective cohort study of critically ill patients transferred by a pediatric transport team from community hospitals to a pediatric referral hospital between 2010 and 2019. We compared outcomes between patients transported via helicopter and patients for whom helicopter transfer was requested but instead came by ambulance due to non-modifiable factors such as weather, a strategy designed to reduce confounding by indication.
Results:
We studied 1,186 trips: 1,044 (88%) via helicopter and 142 (12%) via ground. Transport time in minutes was shorter for helicopter transports (median = 143, IQR: 118-184) compared to ground transports (median = 289, IQR: 213-258; difference in medians = 146, 95% CI: 12 to 168, p < 0.001). In-hospital mortality did not significantly differ between patient groups (helicopter = 5.8%; ground = 7.3%; difference = -1.5%, 95% CI: -6.0% to 3.3%, p = 0.06). ICU length of stay in days was shorter for helicopter transports (median = 2, IQR 1-5) compared to ground transports (median = 3, IQR 1-7), although this difference was not statistically significant (difference in medians: 1, 95% CI -1 to 0, p = 0.11). There was a small but statistically significant difference in median hospital length of stay between patient groups (helicopter = 4 days, IQR: 2-8; ground = 4 days, IQR: 2-11; difference in medians = 0, 95% CI: -2.0 to -0.5, p = 0.049).
Conclusions:
Compared to patients who are transferred by helicopter, patients who would have been transferred by helicopter if available, but were transferred by ground instead, reached their site of definitive care approximately 2.5 hours later. There was no statistically significant difference in mortality, though our results are consistent with a decrease in ICU and hospital length of stay for patients transported by helicopter.