O1063 Oct.4: 4:14pm - Which Children Deteriorate Following Inter-Facility Transport: A Retrospective Look at Patient Disposition Outcomes

Background
Children transported from referring emergency departments (ED) for admission are at risk for early deterioration, however, the incidence is unknown and the children who experience this clinical worsening are not well described. Multiple scoring systems (e.g., transport risk assessment in pediatrics (TRAP) and transport pediatric early warning score (TPEWS)) have failed to reliably predict the need for intensive care admission. We hypothesize that better characterization of these patients will allow for the identification of subgroups of patients with distinct phenotypes who will benefit from additional prehospital, transport, and hospital resources.

Objective
To identify and characterize children who experience in-hospital clinical deterioration within the first 24 hours following interfacility pediatric critical care transport from referring EDs.

Design/Methods
We conducted a retrospective chart review of children < 18 years old who were transported to an urban quaternary pediatric hospital by our critical care transport team who transports 1600 patients per year by all modalities. Data from transports between 1/1/16 and 9/30/19 were obtained from transport logs, rapid response logs, and the electronic medical record. Patients were included if they were admitted directly to the general inpatient unit in the 24 hours prior to clinical deterioration. Deterioration was defined as a call to the Rapid Response Team (RRT), transfer to the intensive care unit (ICU), or need for pediatric acute life support for a cardiac or respiratory event. Patients were excluded if transported by another team, evaluated in our ED, or directed admitted to our ICU. Descriptive statistics were calculated.

Results
There were 1603 study eligible transports during the study period. Of these, 128 (8.0%) experienced clinical deterioration prompting an RRT response within the first 24 hours of hospitalization. Of these, 87 patients (68.0%) were transferred to the ICU within 24 hours of admission, half of which required respiratory intervention (figure 1). Children who experience deterioration were primarily admitted for respiratory conditions (n=78;61%). Other categorical admitting diagnoses, sepsis, neurological, endocrine, gastrointestinal, and other, were less common (table 1). The categorical triggers for the RRT calls consisted of respiratory (n=82;64%), blood pressure/perfusion (n=17;13.3%), cardiac (n=6;4.7%), electrolyte abnormality/other (n=6, 4.7%) and neurological (n=4;3.1%).

Conclusion
The incidence of children who experience deterioration following transport was surprisingly high (8%). The majority of children who experienced early deterioration had a respiratory diagnosis and a respiratory event, likely reflecting the general profile of patients admitted to a freestanding children’s hospital. Next steps will include a comparison of subgroup characteristics based on the presence of deterioration and a detailed data collection, including vital sign ranges, duration of illness, early inventions from the specific cohort of children with deterioration. Group associated clinical factors will be assessed as harbingers for early deterioration.