Keywords
Emergency Service, Hospital
Child
Triage
How to Cite
Abstract
Introduction: Interhospital transport is crucial to ensure access to specialized healthcare services, presenting both a logistic and clinical challenge with significant implications for patient safety and healthcare resource utilization. There are few tools available to predict risks in pediatric transport (PT), so a triage scale could standardize PT and optimize available resources.
Objective: To study the concordance between the current choice of urgent PT resource in Asturias and the ideal recommendation according to the Pediatric Transport Triage Tool (PT3) adapted to our setting, evaluating the impact of its implementation.
Method: Longitudinal observational analytical study of concordance. Urgent PT (1 month to 14 years) were studied over one year between 4 peripheral hospitals and the referral hospital (RH). The main variable was the composition of the transport team.
Results: A total of 150 urgent transports were recorded over 12 months, with a median age of 7,86 years. The most common pathology group was surgical. The most frequent destination was the RH emergency department. A weighted kappa of 0.68 (p<0.001) was obtained for the choice of transport team, with the highest discordance found in transfers involving nursing staff. The application of the scale would have resulted in reduced costs and greater availability of personnel for other transfers, with no impact on patient safety.
Conclusions: We consider the adapted PT3 tool to be easy to use, useful for standardizing PT, reducing variability in decision-making, and optimizing resources. Future research should cover all pediatric age groups and other regions.
References
Barry PW, Ralston C. Adverse events occurring during inter-hospital transfer of the critically ill. Arch Dis Child. 1994; 71: 8-11. https://doi.org/10.1136/adc.71.1.8
Sociedad Española de Cuidados Intensivos Pediátricos. Perfil competencial del médico que realiza transporte pediátrico. [Internet]. Madrid: Sociedad Española de Cuidados Intensivos Pediátricos; 2018 Feb [consultado 13 jul 2024]. Disponible en: https://secip.com/images/uploads/2018/05/perfil-competencial-medico-que-r-ealiza-transporte-pediatrico22022018.pdf
American Academy of Pediatrics. Committee on Pediatric Emergency Medicine. American College of Critical Care Medicine. Society of Critical Care Medicine. Consensus report for regionalization of services for critically ill or injured children. Pediatrics. 2000; 105(1 Pt 1): 152-5. https://doi.org/10.1542/peds.105.1.152
Usher R. Changing mortality rates with perinatal intensive care and regionalization. Semin Perinatol. 1977; 1(3): 309-19.
Consensus report for regionalization of services for critically ill or injured children. Council of the Society of Critical Care Medicine. Crit Care Med. 2000; 28(1): 236-9. https://doi.org/10.1097/00003246-200001000-00040
Millán García Del Real N, Sánchez García L, Ballesteros Diez Y, Rodríguez Merlo R, Salas Ballestín A, Jordán Lucas R et al. Importance of specialized paediatric and neonatal transport. Current situation in Spain: Towards a more equitable and universal future. An Pediatr (Engl Ed). 2021; 95(6): 485.e1-e10. https://doi.org/10.1016/j.anpede.2021.06.010
de la Mata S, Escobar M, Cabrerizo M, Gómez M, González R, López-Herce Cid J; Grupo de estudio del transporte pediátrico. Pediatric and neonatal transport in Spain, Portugal and Latin America. Med Intensiva. 2017; 41(3): 143-52. https://doi.org/10.1016/j.medin.2015.12.013
Karlsen KA, Trautman M, Price-Douglas W, Smith S. National survey of neonatal transport teams in the United States. Pediatrics. 2011; 128(4): 685-91. https://doi.org/10.1542/peds.2010-3796
Brønnum Nystrup K, Poorisrisak P, Breindahl M, Hallas P. Interhospital Transport of Pediatric Patients in Denmark: A Survey of Current Practice. Pediatr Emerg Care. 2020; 36(8): 389-92. https://doi.org/10.1097/PEC.0000000000001586
Ramnarayan P, Dimitriades K, Freeburn L, Kashyap A, Dixon M, Barry PW et al. United Kingdom Paediatric Intensive Care Society Acute Transport Group. Interhospital transport of critically Ill children to PICUs in the United Kingdom and Republic of Ireland: Analysis of an international dataset. Pediatr Crit Care Med. 2018; 19(6): e300-e11. https://doi.org/10.1097/PCC.0000000000001506
Garrido-Conde B, Millán-García N, Esclapés-Giménez T, Marsinyach-Ros I, Toledo-Parreño J, Núñez-Cárdenas M. et al. Desarrollo de un sistema de indicadores para la evaluación de la calidad en transporte interhospitalario: proyecto multicéntrico. An Pediatr (Barc). 2021; 95(3): 167-73. https://doi.org/10.1016/j.anpedi.2020.09.014
Orr RA, Felmet KA, Han Y, McCloskey KA, Dragotta MA, Bills DM et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics. 2009; 124(1): 40-8. https://doi.org/10.1542/peds.2008-0515
Sociedad Española de Cuidados Intensivos Pediátricos. Transporte intrahospitalario en el paciente crítico pediátrico. [Internet]. Madrid: Sociedad Española de Cuidados Intensivos Pediátricos; 2020 Jul [consultado 11 jul 2024]. Disponible en: https://secip.com/images/uploads/2020/07/Transporte-intrahospitalario-en-el-paciente-cr%C3%ADtico-pedi%C3%A1trico.pdf
American Academy of Pediatrics Section on Transport Medicine. Guidelines for air & ground transport of neonatal and pediatric patients manual. 4 ed. American Academy of Pediatrics; 2015. p. 331-52.
Molinos C. Transporte pediátrico interhospitalario en Asturias. Tesis doctoral. Oviedo: Universidad de Oviedo, 2006.
Badía M, Armendáriz JJ, Vilanova C, Sarmiento O, Serviá L, Trujillano J. Transporte interhospitalario de largo recorrido. Utilidad de las escalas de gravedad. Med Intensiva. 2009; 33: 217-23. https://doi.org/10.1016/S0210-5691(09)71755-3
Moreno E, Serrano S, Bóveda J, Echevarría MJ, Muñoz J, Diego A. Sistema de valoración de pacientes para el transporte sanitario. Resultados de su aplicación en traslados secundarios. Med Intensiva. 1988; 12: 432-8.
Moreno-Millan E, Prieto-Valderrey F. Escalas de valoración del riesgo para el transporte interhospitalario de pacientes críticos: ¿índices de gravedad o de necesidad de soportes? Med Intensiva. 2010; 34(1): 79-82. https://doi.org/10.1016/j.medin.2009.09.005
Etxebarría MJ, Serrano S, Ruiz Ribó D, Cía MT, Olaz F, López J. Prospective application of risk scores in the interhospital transport of patients. Eur J Emerg Med. 1998; 5(1): 13-7. https://doi.org/10.1097/00063110-199803000-00005
Cardenete Reyes C, Polo Portes CE, Téllez Galán G. Escala de valoración del riesgo del transporte interhospitalario de pacientes críticos: su aplicación en el Servicio de Urgencias Médicas de Madrid (SUMMA 112). Emergencias. 2011; 23: 35-8.
González MJ, Cortés JD, Mariscal MI, Pacheco E. Justificación de la implantación de una escala de valoración para el traslado interhospitalario en la Comunidad de Madrid para la optimización de recursos. [Internet]. Premios Profesor Barea. 13ª ed, 2015 [consultado 15 oct 2024]. Disponible en: https://www.fundacionsigno.com/archivos/7_Accesit_2_mod_3.pdf
Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med. 1996; 24(5): 743-52. https://doi.org/10.1097/00003246-199605000-00004
Holt T, Prodanuk M, Hansen G. Utilizing pediatric scoring systems to predict disposition during interfacility transport. Prehosp Emerg Care. 2019; 23(2): 249-53. https://doi.org/10.1080/10903127.2018.1491658
Kandil SB, Sanford HA, Northrup V, Bigham MT, Giuliano JS Jr. Transport disposition using the Transport Risk Assessment in Pediatrics (TRAP) score. Prehosp Emerg Care. 2012; 16(3): 366-73. https://doi.org/10.3109/10903127.2012.664246
Petrillo-Albarano T, Stockwell J, Leong T, Hebbar K. The use of a modified pediatric early warning score to assess stability of pediatric patients during transport. Pediatr Emerg Care. 2012; 28(9): 878-82. https://doi.org/10.1097/PEC.0b013e31826763a3
Markakis C, Dalezios M, Chatzicostas C, Chalkiadaki A, Politi K, Agouridakis PJ. Evaluation of a risk score for interhospital transport of critically ill patients. Emerg Med J. 2006; 23(4): 313-7. https://doi.org/10.1136/emj.2005.026435
Steffen KM, Noje C, Costabile PM, Henderson E, Hunt EA, Klein BL, et al. Pediatric transport triage. Development and Assessment of an objective tool to guide transport planning. Pediatr Emer Care. 2020; 36: 240-7. https://doi.org/10.1097/PEC.0000000000001641
Sociedad Asturiana de Estudios Económicos y Sociales. Reseña estadística de los municipios asturianos. [Internet]. Oviedo: Sociedad Asturiana de Estudios Económicos y Sociales; 2024 [consultado el 13 dic 2024]. Disponible en: https://www.sadei.es/sadei/resena-estadistica-de-los-municipios-asturianos/resena-estadistica-de-los-municipios-asturianos.-aplicacion-de-consulta_1547_341_4180_0_1_publi.html
Plataforma de contratación del sector público [Internet]. Gobierno de España. 2021 [consultado el 14 jul 2024]. Disponible en: https://contrataciondelestado.es/wps/portal/!ut/p/b0/04_Sj9CPykssy0xPLMnMz0vMAfIjU1JTC3Iy87KtUlJLEnNyUuNzMpMzSxKTgQr0w_Wj9KMyU1zLcvQj3VxzkyOKvMpVDYwTIwLDDMJdzXMiA8ptbfULcnMdAdyP_Y4!/
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2025 Boletín de Pediatría