Design and evaluation of a new paediatric pretransport risk score
- Autores: F. Rosés Noguer
- Directores de la Tesis: Antonio Moreno Galdó (dir. tes.), Cèsar W. Ruiz Campillo (codir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2018
- Idioma: español
- Tribunal Calificador de la Tesis: C. Rodrigo Gonzalo de Liria (presid.), Josep Perapoch López (secret.), Rosa Collell (voc.)
- Programa de doctorado: Programa de Doctorado en Pediatría, Obstetricia y Ginecología por la Universidad Autónoma de Barcelona
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- Resumen
DESIGN AND EVALUATION OF A NEW PAEDIATRIC PRETRANSPORT RISK SCORE Introduction: Advances in medical technology have been associated with an improvement in clinical outcomes for paediatric patients admitted in intensive care units. The complexity of the ICU has led to centralization of care with high volume and complexity centers. In order to offer the same care to all the population independently of where they live, the role of the interhospital transport system has become essential in order to guarantee the same clinical outcomes. As far as we know there is no standardised score system specifically designed to use pre transport clinical data to predict mortality and tertiary centre disposition. With this study we seek to design and validate a novel Paediatric PreTransport Risk Score (PPTRS).
Patients and Methods: We designed a prospective observational study of paediatric patients transported by the paediatric transport retrieval team of Vall d’Hebron Hospital (SEM-P VH)) since to 1st of October 2010 until 30th July 2017. The study population included all paediatric patients, from 0 days of life to 16 y old that were transported by our SEM-P VH. A PPTRS was designed including 10 clinical variables (respiration, pulse oximetry, peak inspiratory pressure, systolic blood pressure, consciousness, pupils, diuresis, standard base excess, glucose and temperature) obtained during the first contact call with the coordination center.
Results: Out of a total of 4292 patients initially entered into our database, 854 (19.8%) cases were excluded leaving a total of 3439 patients for the final analysis. The age distribution demonstrated that 1597 (46.4%) of our patients were neonates, with 503 (14.6%) of them that were preterm neonates and 1842 (53.6%) were children. The main pathological group of our cohort was respiratory with 1402 patients (40.8%), followed by neurological causes with 716 patients (20.8%) and cardiac, with 378 patients (11.0%). The majority of patients, 2344 (68.2%), were admitted into intensive care units at their receiving hospitals. Only 165 (4.8%) patients were felt to need urgent surgery. The overall mortality at the end of transport was 0.5% with 16 patients that died at the time of arrival at the destination hospital. Mean PPTRS was 4.55 ± 2.77 with a median of 4.0 (0-17). A total of 65 (1.9%) of the patients died after 48 hours of the transport. Patients who died had a significantly higher PPTRS compared with those patients that were alive 48 h after transport (10.95 ± 3.59 vs 4.42 ± 2.57 p <0.001) and multivariate analysis showed that PPTRS was the only independent factor for mortality (OR: 1.744 (95% CI: 1.599-1.902; p < 0.001). Patients admitted in intensive care had a significantly higher PPTRS compared with those patients who did not require admission in intensive care (3.32 ± 1.77 vs 5.07 ± 2.88; p <0.001). Furthermore, higher PPTRS were associated with higher risk of all medical interventions but insertion of a peripheral vain access. Antiepileptic drugs and the use of cervical collar did not have any relation with the PPTRS.
Conclusions: The PPTRS is a simple and useful scoring system to predict the mortality 48 h after transport, need for ICU and need for medical interventions.
