Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study

Padmanabhan Ramnarayan, Krish Thiru, Roger C Parslow, David A Harrison, Elizabeth S Draper, Kathy M Rowan
Lancet 2010 August 28, 376 (9742): 698-704

BACKGROUND: Intensive care services for children have undergone substantial centralisation in the UK. Along with the establishment of regional paediatric intensive care units (PICUs), specialist retrieval teams were set up to transport critically ill children from other hospitals. We studied the outcome of children transferred from local hospitals to PICUs.

METHODS: We analysed data that were gathered for a cohort of children (<or=16 years) admitted consecutively to 29 PICUs in England and Wales during 4 years (Jan 1, 2005, to Dec 31, 2008). We compared unplanned admissions from wards within the same hospital as the PICU and from other hospitals; interhospital transfers by non-specialist and specialist retrieval teams; and patients transferred to their nearest PICU and those who were not. Primary outcome measures were mortality rate in PICU and length of stay in PICU. We analysed data by use of logistic regression analysis.

FINDINGS: There were 57 997 admissions to PICUs during the study. Nearly half of unplanned admissions (17 649 [53%] of 33 492) were from other hospitals. Although children admitted from other hospitals were younger (median 10 months [IQR 1-55] vs 18 months [3-85]), sicker at admission (median predicted risk of mortality 6% [4-10] vs 4% [2-7]), stayed longer in PICUs (75 h [33-153] vs 43 h [18-116]), and had higher crude mortality rates (1384 [8%] of 17 649 vs 996 [6%] of 15 843; odds ratio 1.27, 95% CI 1.16-1.38), the risk-adjusted mortality rate in PICUs was lower than among children admitted from within the same hospital (0.65, 0.53-0.80). In a multivariable analysis, use of a specialist retrieval team for transfer was associated with improved survival (0.58, 0.39-0.87).

INTERPRETATION: These findings support the policy of combining centralisation of intensive care services for children with transfer by specialist retrieval teams.

FUNDING: National Clinical Audit and Patient Outcomes Programme through Healthcare Quality Improvement Partnership, Health Commission Wales Specialised Services, National Health Service (NHS) Lothian and National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, and the Pan Thames PICU Commissioning Consortium.

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