Decision-making for children requiring interhospital transport: assessment of a novel triage tool

• Published in: Archives of disease in childhood 2021-12, Vol.106 (12), p.1184-1190
• Main Authors: Slater, Anthony, Crosbie, Deanne, Essenstam, Dionne, Hoggard, Brett, Holmes, Paul, McEniery, Julie, Thompson, Michelle
• Format: Article
• Language: English
• Subjects: Ambulance services; Attrition (Research Studies); Child; Child Health; Child, Preschool; Children; Children & youth; Clinical decision making; Continuity of care; Coordination; Critical care; Critical Illness - therapy; Decision Making; Epidemiology; Female; Hospitals; Humans; Infant; Intensive care; Intensive Care Units, Pediatric - organization & administration; Male; Medical referrals; Morbidity; Mortality; Mortality risk; New South Wales; Nurses; Observational studies; Original research; Patient Transfer; Patients; Pediatrics; Physicians; physiology; Prospective Studies; Referral; Risk reduction; Transportation of Patients; Trauma; Triage - methods; Triage - organization & administration; Vital signs
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2019-318634

ObjectiveThe use of specialist retrieval teams to transport critically ill children is associated with reduced risk-adjusted mortality and morbidity; however, there is a paucity of data to guide decision-making related to retrieval team activation. We aimed to assess the accuracy of a novel triage tool designed to identify critically ill children at the time of referral for interhospital transport.DesignProspective observational study.SettingRegional paediatric retrieval and transport services.PatientsData were collected for 1815 children referred consecutively for interhospital transport from 87 hospitals in Queensland and northern New South Wales.InterventionImplementation of the Queensland Paediatric Transport Triage Tool.Main outcome measuresAccuracy was assessed by calculating the sensitivity, specificity and negative predictive value for predicting transport by a retrieval team, or admission to intensive care following transport.ResultsA total of 574 (32%) children were transported with a retrieval team. Prediction of retrieval (95% CIs): sensitivity 96.9% (95% CI 95.1% to 98.1%), specificity 91.4% (95% CI 89.7% to 92.9%), negative predictive value 98.4% (95% CI 97.5% to 99.1%). There were 412 (23%) children admitted to intensive care following transport. Prediction of intensive care admission: sensitivity 96.8% (95% CI 94.7% to 98.3%), specificity 81.2% (95% CI 79.0% to 83.2%), negative predictive value 98.9% (95% CI 98.1% to 99.4%).ConclusionsThe triage tool predicted the need for retrieval or intensive care admission with high sensitivity and specificity. The high negative predictive value indicates that, in our setting, children categorised as acutely ill rather than critically ill are generally suitable for interhospital transport without a retrieval team.