1
|
Jung D, Jung JH, Kim JH, Jue JH, Park JW, Kim DK, Jung JY, Lee EJ, Lee JH, Suh D, Kwon H. The Association Between Inter-Hospital Transfers and the Prognosis of Pediatric Injury in the Emergency Department. J Korean Med Sci 2024; 39:e2. [PMID: 38193324 PMCID: PMC10782044 DOI: 10.3346/jkms.2024.39.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/16/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Inter-hospital transfers of severely injured patients are inevitable due to limited resources. We investigated the association between inter-hospital transfer and the prognosis of pediatric injury using the Korean multi-institutional injury registry. METHODS This retrospective observational study was conducted from January 2013 to December 2017; data for hospitalized subjects aged < 18 years were extracted from the Emergency Department-based Injury in Depth Surveillance database, in which 22 hospitals are participating as of 2022. The survival rates of the direct transfer group and the inter-hospital transfer group were compared, and risk factors affecting 30-day mortality and 72- hour mortality were analyzed. RESULTS The total number of study subjects was 18,518, and the transfer rate between hospitals was 14.5%. The overall mortality rate was 2.3% (n = 422), the 72-hour mortality was 1.7% (n = 315) and the 30-day mortality rate was 2.2% (n = 407). The Kaplan-Meier survival curve revealed a lower survival rate in the inter-hospital transfer group than in the direct visit group (log-rank, P < 0.001). Cox proportional hazards regression analysis showed that inter-hospital transfer group had a higher 30-day mortality rate and 72-hour mortality (hazard ratio [HR], 1.681; 95% confidence interval [CI], 1.232-2.294 and HR, 1.951; 95% CI, 1.299-2.930) than direct visit group when adjusting for age, sex, injury severity, and head injury. CONCLUSION Among the pediatric injured patients requiring hospitalization, inter-hospital transfer in the emergency department was associated with the 30-day mortality rate and 72-hour mortality rate in Korea.
Collapse
Affiliation(s)
- Darjin Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Hee Jung
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Korea.
| | - Jin Hee Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jie Hee Jue
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eui Jun Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
2
|
Response to: Helicopter versus ground ambulance transport for interfacility transfer of critically ill children: Care impact outcome more than the mode of transport. Am J Emerg Med 2023; 63:140. [PMID: 36335062 DOI: 10.1016/j.ajem.2022.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 12/05/2022] Open
|
3
|
Joseph AM, Horvat CM, Evans IV, Kuch BA, Kahn JM. Helicopter versus ground ambulance transport for interfacility transfer of critically ill children. Am J Emerg Med 2022; 61:44-51. [PMID: 36037589 DOI: 10.1016/j.ajem.2022.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/07/2022] [Accepted: 08/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Following initial stabilization, critically ill children often require transfer to a specialized pediatric hospital. While the use of specialized pediatric transport teams has been associated with improved outcomes for these patients, the additional influence of transfer mode (helicopter or ground ambulance) on clinical outcomes remains unknown. METHODS We investigated the association between transport mode and outcomes among critically ill children transferred to a single pediatric hospital via a specialized pediatric transport team. We designed a retrospective cohort study to reduce indication bias by limiting analysis to patients for whom a helicopter transport was initially requested. We compared outcomes for those who ultimately traveled via helicopter, and for those who ultimately traveled via ground ambulance due to non-clinical factors. RESULTS We compared transport times, in-hospital mortality, and hospital length of stay by transport mode. Transport time in minutes was shorter for helicopter transports (median = 143, interquartile range [IQR]: 118-184) compared to ground ambulance transports (median = 289, IQR: 213-258; difference in medians = 146, 95% CI: 12 to 168, p < 0.001). In unadjusted analysis, helicopter transport was not associated with a difference in in-hospital mortality (helicopter = 6.0%, ground ambulance = 7.0%; 95% CI for difference: -6.6% to 3.3%; p = 0.64) but was associated with a statistically significant reduction in median hospital days (helicopter = 4, ground ambulance = 5; 95% CI -3 to 0; p = 0.04). In adjusted analyses, there were no statistically significant associations. These results were consistent across sensitivity analyses. CONCLUSIONS Among critically ill pediatric patients without traumatic injuries transported by a specialty team, those patients who would have been transferred by helicopter if available but were instead transferred by ground ambulance reached their site of definitive care approximately 2.5 h later. Helicopter transport for these patients was not associated with in-hospital mortality, but was potentially associated with reduced hospital length of stay.
Collapse
Affiliation(s)
- Allan M Joseph
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America.
| | - Christopher M Horvat
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America.
| | - Idris V Evans
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America.
| | - Bradley A Kuch
- Center for Emergency Medicine of Western Pennsylvania and STAT MedEvac, Pittsburgh, PA, United States of America.
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; Department of Health Policy & Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States of America.
| |
Collapse
|
4
|
Millán García Del Real N, Sánchez García L, Ballesteros Diez Y, Rodríguez Merlo R, Salas Ballestín A, Jordán Lucas R, de Lucas García N. Importance of specialized paediatric and neonatal transport. Current situation in Spain: Towards a more equitable and universal future. An Pediatr (Barc) 2021; 95:485.e1-485.e10. [PMID: 34857500 DOI: 10.1016/j.anpede.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022] Open
Abstract
Specialized paediatric and neonatal transport is a useful and essential resource in the interhospital transfer of these patients. It allows bringing the material and personal resources of an intensive care unit closer to the regional hospitals where the patient can be found. The benefits of these teams are very well demonstrated in the literature. These units should be part of the emergency systems, while it would be recommended that they be staff integrated in the tertiary hospitals, in order to maintain the necessary skills and competencies. The team, made up of physicians, nurses and emergency medical technicians, must master both the pathophysiology of transport and that of the critical patient in this age range. A high quality of both human and care is important, so continuous training and periodic recycling will be essential to be compliant with the quality indicators in transport. Likewise, it is essential to have specific vehicles adapted to this function, which allow carrying the wide variety of necessary material, as well as the electromedicine that is required. However, in Spain this paediatric and neonatal transport model is not standardized and therefore is not homogeneous: there are different models that do not always provide adequate quality, making it necessary to implement specialized units throughout the country to guarantee sanitary transport quality to any critical child or neonate.
Collapse
Affiliation(s)
- Nuria Millán García Del Real
- Servicio de Emergencias Médicas Pediátricas, Cataluña, Spain; Unidad de Cuidados Intensivos Pediátricos, Hospital San Juan de Dios, Cataluña, Spain; Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP).
| | - Laura Sánchez García
- Servicio de Neonatología del Hospital Universitario La Paz, Madrid, Spain; Equipo de Transporte Neonatal de la Comunidad de Madrid, Madrid, Spain; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología, Spain
| | - Yolanda Ballesteros Diez
- Servicio de Urgencias del Hospital Universitario Cruces, Bilbao, Spain; Grupo de trabajo de Paciente Crítico de la Sociedad Española de Urgencias de Pediatría
| | - Raquel Rodríguez Merlo
- SUMMA112 Madrid, Madrid, Spain; Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias
| | - Alberto Salas Ballestín
- Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP); Unidad de Transporte Pediátrico de Baleares, Islas Baleares, Spain; Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Raquerl Jordán Lucas
- Servicio de Neonatología del Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología
| | - Nieves de Lucas García
- Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias; SAMUR-Protección Civil de Madrid, Madrid, Spain
| |
Collapse
|
5
|
Browning Carmo K, McCarron M, Kendrick T, Gallagher P, Roxburgh J, Berry A. Re Pathways and factors that influence time to definitive trauma care for injured children in New South Wales, Australia by Curtis et al. published in 2021. Injury 2021; 52:2483-2485. [PMID: 33766432 DOI: 10.1016/j.injury.2021.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023]
Affiliation(s)
- K Browning Carmo
- New South Wales Newborn & paediatric Emergency Transport Service, Australia; University of Sydney, Australia.
| | - M McCarron
- New South Wales Newborn & paediatric Emergency Transport Service, Australia; University of Sydney, Australia
| | - T Kendrick
- New South Wales Newborn & paediatric Emergency Transport Service, Australia
| | - P Gallagher
- New South Wales Newborn & paediatric Emergency Transport Service, Australia
| | - J Roxburgh
- New South Wales Newborn & paediatric Emergency Transport Service, Australia
| | - A Berry
- New South Wales Newborn & paediatric Emergency Transport Service, Australia
| |
Collapse
|
6
|
Millán García Del Real N, Sánchez García L, Ballesteros Diez Y, Rodríguez Merlo R, Salas Ballestín A, Jordán Lucas R, de Lucas García N. [Importance of specialized paediatric and neonatal transport. Current situation in Spain: Towards a more equitable and universal future]. An Pediatr (Barc) 2021; 95:S1695-4033(21)00221-6. [PMID: 34304986 DOI: 10.1016/j.anpedi.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
Specialized paediatric and neonatal transport is a useful and essential resource in the interhospital transfer of these patients. It allows bringing the material and personal resources of an intensive care unit closer to the regional hospitals where the patient can be found. The benefits of these teams are very well demonstrated in the literature. These units should be part of the emergency systems, while it would be recommended that they would be staff integrated in the tertiary hospitals, in order to maintain the necessary skills and competencies. The team, made up of physicians, nurses and emergency medical technicians, must master both the pathophysiology of transport and that of the critical patient in this age range. A high-quality of both human and care is important, so continuous training and periodic recycling will be essential to be compliant with the quality indicators in transport. Likewise, it is essential to have specific vehicles adapted to this function, which allow carrying the wide variety of necessary material, as well as the electromedicine that is required. However, in Spain this paediatric and neonatal transport model is not standardized and, therefore, is not homogeneous: there are different models that do not always provide adequate quality, making it necessary to implement specialized units throughout the country to guarantee sanitary transport quality to any critical child or neonate.
Collapse
Affiliation(s)
- Nuria Millán García Del Real
- Servicio de Emergencias Médicas Pediátricas, Cataluña, España; Unidad de Cuidados Intensivos Pediátricos, Hospital San Juan de Dios, Cataluña, España; Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP).
| | - Laura Sánchez García
- Servicio de Neonatología del Hospital Universitario La Paz, Madrid, España; Equipo de Transporte Neonatal de la Comunidad de Madrid, Madrid, España; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología, España
| | - Yolanda Ballesteros Diez
- Servicio de Urgencias del Hospital Universitario Cruces, Bilbao, España; Grupo de trabajo de Paciente Crítico de la Sociedad Española de Urgencias de Pediatría
| | - Raquel Rodríguez Merlo
- SUMMA112 Madrid, Madrid, España; Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias
| | - Alberto Salas Ballestín
- Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP); Unidad de Transporte Pediátrico de Baleares, Islas Baleares, España; Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Son Espases, Palma de Mallorca, España
| | - Raquel Jordán Lucas
- Servicio de Neonatología del Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología
| | - Nieves de Lucas García
- Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias; SAMUR-Protección Civil de Madrid, Madrid, España
| |
Collapse
|
7
|
Huang Y, Kissee JL, Dayal P, Wang NE, Sigal IS, Marcin JP. Association Between Insurance and Transfer of Injured Children From Emergency Departments. Pediatrics 2017; 140:peds.2016-3640. [PMID: 28928288 DOI: 10.1542/peds.2016-3640] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if injured children presenting to nondesignated trauma centers are more or less likely to be transferred relative to being admitted based on insurance status. METHODS We conducted a cross-sectional study by using the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Pediatric trauma patients receiving care in emergency departments (EDs) at nontrauma centers who were either admitted locally or transferred to another hospital were included. We performed logistic regression analysis adjusting for injury severity and other confounders and incorporated nationally representative weights to determine the association between insurance and transfer or admission. RESULTS Nine thousand four hundred and sixty-one ED pediatric trauma events at 386 nontrauma centers met inclusion criteria. EDs that treated a higher proportion of patients with Medicaid had higher odds of transfer relative to admission (odds ratio [OR]: 1.2 per 10% increase in Medicaid; 95% confidence interval [CI]: 1.1-1.4), resulting in overall higher odds of transfer among patients with Medicaid compared with patients with private insurance (OR: 1.3; 95% CI: 1.0-1.5). A patient's insurance status was not associated with different odds of transfer relative to admission within individual EDs after adjusting for the ED's proportion of patients with Medicaid (Medicaid OR: 1.0; 95% CI: 0.8-1.1). CONCLUSIONS Injured pediatric patients presenting to nondesignated trauma centers are slightly more likely to be transferred than admitted when the ED treats a higher proportion of Medicaid patients. In this study, ongoing concerns about inequities in the delivery of care among hospitals treating high proportions of children with Medicaid are reinforced.
Collapse
Affiliation(s)
- Yunru Huang
- Department of Pediatrics, University of California, Davis, Sacramento, California; and
| | - Jamie L Kissee
- Department of Pediatrics, University of California, Davis, Sacramento, California; and
| | - Parul Dayal
- Department of Pediatrics, University of California, Davis, Sacramento, California; and
| | - Nancy Ewen Wang
- Division of Emergency Medicine, Department of Surgery, Stanford University, Stanford, California
| | - Ilana S Sigal
- Department of Pediatrics, University of California, Davis, Sacramento, California; and
| | - James P Marcin
- Department of Pediatrics, University of California, Davis, Sacramento, California; and
| |
Collapse
|