CRITICAL CARE PEDIATRICIAN-LED AEROMEDICAL TRANSPORTS - PHYSICIAN INTERVENTIONS AND PREDICTIVENESS OF OUTCOME

This article reviews the one-year experience (March 28, 1987 to March 27, 1988) of the pediatric transport service of the University of Wisconsin Hospital and Clinics (UWHC). The UWHC pediatric transport team consisted of a critical care flight nurse and a pediatric critical care attending physician or fellow. The aims of the study were to: 1) determine the types and number of interventions performed by the physicians to gauge the need for physician presence on transport; and 2) determine which variables (severity of illness scores, age, gender, distance from hospital) recorded at the time of the referral telephone call best predicted outcome of the patient. There were 109 children transported by helicopter during the one-year study period. Thirty percent of the patients (43% of trauma patients and 22% of medical patients) had no interventions at all, 18% of medical patients and 10% of trauma patients were intubated, and 9% of medical patients and no trauma patients had central venous catheters inserted. Multivariate modeling determined that among medical patients, outcome could be accurately predicted only 38% of the time if telephone PRISM (Pediatric Risk of Mortality) scores were determined. Among trauma patients, if gender, age, distance from UWHC, and telephone PRISM scores were known, outcome could be predicted 74% of the time. Unless studies show the benefit of pediatrician-accompanied transport, transports could probably be done without critical care pediatricians. Severity of illness scoring at this time is probably not sufficiently accurate to warrant its use for deciding the appropriateness of transport of pediatric patients.