O1062 Oct.4: 4:07pm - The Impact of Early Critical Care delivered by a Specialized Pediatric Transport Team at a Satellite Children’s Hospital

Background: Arkansas Children’s Hospital (ACH), located in central Arkansas, is the only tertiary care children’s hospital in the state. ACH recently opened a satellite children’s hospital (ACNW) in Northwest Arkansas, to serve one of the top five fastest growing regions in the country. ACNW is a 24-bed satellite hospital providing emergency medicine services and inpatient care for non-critically ill children in the region. Patients requiring services not available at ACNW are transported to ACH via Angel One Transport (AOT), a specialized pediatric RN/RT team housed at ACH. Distance between the two facilities one way is approximately 70 minutes by air and 3.5 hours by ground. Between January and March 2020, an AOT team was stationed at ACNW on a trial basis, for 3 shifts per week. Our previous NIH-funded work showed that rapid delivery of critical care by a specialized pediatric transport team improves outcomes of critically ill children. We hypothesized that early delivery of definitive care by the AOT team stationed at ACNW would improve outcomes of critically ill pediatric patients.

Methods: A retrospective comparison of all patients transported from ACNW to ACH during the study period (Jan-March 2020) was performed. Demographics, diagnosis, interventions, and outcomes were compared between the two groups. Mean values were compared using student’s t-test. Proportions were compared using chi-square test. All comparisons were two-sided and p ≤ 0.05 was used for statistical significance.

Results: 64 patients were transported in the study period; 38 by the ACH-based team and 26 by the ACNW-based team. Age in years [5.016.36(ACH) vs. 4.604.66(ACNW); p=0.75], diagnosis category [respiratory illness: 68.42%(ACH) vs. 57.69%(ACNW); p=0.38], and patients requiring endotracheal intubation [10.71%(ACH) vs. 16.67%(ACNW); p=0.49] were similar. Mode of transport [air: 63.16%(ACH) vs. 46.15%(ACNW); p=0.18] and transport time [minutes: 266.21101.86(ACH) vs. 259.7287.54(ACNW); p=0.79] were also similar. More patients in the ACNW group received vasoactive infusions [0%(ACH) vs. 15.38%(ACNW); p=0.01]. There was a trend toward shorter hospital length of stay (LOS) and ICU length of stay (ICULOS) in the ACNW group [LOS(days): 7.798.29(ACH) vs. 5.266.13(ACNW); p=0.19; ICULOS(days): 3.093.16(ACH) vs. 2.082.39(ACNW); p=0.34]. A sample size calculation was performed for LOS with 80% power and =0.05. 338 patients would be required to show a statistically significant difference in LOS of 2 days.

Conclusion: Our study identified a trend toward improved outcomes with early clinical intervention by a remotely-stationed specialized pediatric transport team. Although statistical significance was not reached, a sample size calculation identified a larger study population is needed. These findings complement our previous NIH-funded work. Multi-center collaborative research is urgently needed to evaluate the impact of early critical care provided by specialized pediatric transport teams on relevant outcomes in critically ill children.