BMJ 1995;311:836-839 (30 September)

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Morbidity and severity of illness during interhospital transfer: impact of a specialised paediatric retrieval team

Joseph Britto, paediatric intensive care fellow,a Simon Nadel, consultant in paediatric intensive care,a Ian Maconochie, clinical research fellow,a Michael Levin, professor,a Parviz Habibi, senior lecturer a

a Department of Paediatrics, St Mary's Hospital, London W2 1NY

Correspondence to: Dr Britto.

Abstract

Objective: To evaluate the morbidity and severity of illness during interhospital transfer of critically ill children by a specialised paediatric retrieval team.
Design: Prospective, descriptive study.
Setting: Hospitals without paediatric intensive care facilities in and around the London area, and a paediatric intensive care unit at a tertiary centre.
Subjects: 51 critically ill children transferred to the paediatric intensive care unit.
Main outcome measures: Adverse events related to equipment and physiological deterioration during transfer. Paediatric risk of mortality score before and after retrieval. Therapeutic intervention score before and after arrival of retrieval team.
Results: Two (4%) patients had preventable physiological deterioration during transport. There were no adverse events related to equipment. Severity of illness decreased during stabilisation and transport by the retrieval team, suggested by the difference between risk of mortality scores before and after retrieval (P<0.001). The median (range) difference between the two scores was 3.0 (-6 to 17). Interventions during stabilisation by the retrieval team increased, demonstrated by the difference between intervention scores before and after retrieval, median (range) difference between the two scores being 6 (-8 to 38) (P<0.001).
Conclusions: Our study indicates that a specialised paediatric retrieval team can rapidly deliver intensive care to critically ill children awaiting transfer. Such children can be transferred to a paediatric intensive care unit with minimal morbidity and mortality related to transport. There was no deterioration in the clinical condition of most patients during transfer.

Key messages

  • Key messages

  • The transfer of a critically ill child is inherently risky; up to 75% of patients transferred by non-specialised teams can suffer from serious clinical complications

  • These risks can be considerably reduced if a pecialised retrieval team stabilises the patient and establishes intensive care at the referring hospital before transfer

  • In this study physiological deterioration occurred in only two of 51 patients during transport, and there were no instances of adverse events related to equipment

  • There was no deterioration in the clinical condition of most patients during transfer


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