PICU Fellow Cohen Children's Medical Center Queens, New York, United States
Background: The safe and efficient transport of pediatric patients from a referring emergency department to definitive care at a children’s hospital requires a high-functioning Critical Care Transport (CCT) team. Given the limited resources of the CCT team and the challenging clinical environment of the transport setting, early identification of patients at risk for deterioration during transport and appropriation of a specialized pediatric team are paramount for high quality care and safe transport. We developed a tool to identify high risk patients in the transport setting by modifying the Pediatric Transport Triage Tool (PT3) and incorporating physiologic parameters used by the hospital’s Pediatric Early Warning Score (PEWS). The product was called the Transport Pediatric Early Warning Score (T-PEWS). Objective: We aim to describe the ability of the T-PEWS score to reliably predict resource utilization in a high volume pediatric transport program. Design/Methods: This is a retrospective analysis of pediatric patients (0-18 years) transported to our single institution, a tertiary care children’s hospital in a large metropolitan area. As per protocol, CCT nurses (CCT-RN) calculated a T-PEWS score for consecutive patients based on physiologic data, as well as high-risk diagnoses and laboratory or graphic findings. We evaluated the rate of completion, concordance of predicted vs. actual resource utilization, and rates of over- and under-triage. Results: We identified 1,127 patients from June 2023 – September 2023. A T-PEWS score was calculated for 1,115 (98.9%). When evaluating the dispatched resources (team composition) with the team composited predicted by the T-PEWS algorithm, the concordance rate was 84.5%. The tool’s monthly over triage rate, as defined as predicting a need for more resources than determined by medical control, averaged 7.4% (range 5.0-10.2%). The under-triage rate, which reflects the rate at which the predicted team composition was below that required as determined by medical control, occurrence of adverse events during transport and need to upgrade team after dispatch, averaged 1.2% (range 0.33 – 2.6%). There were 7 adverse events with an adverse event rate of 0.62%.
Conclusion(s): The use of a severity scoring tool such as T-PEWS in a high volume pediatric transport program can reliably assist in predicting acuity and matching transport resources.
