EFFECTS OF PATIENT-AND-TEAM-RELATED FACTORS ON STABILIZATION TIME DURING PEDIATRIC INTENSIVE CARE TRANSPORT

Borrows E, Lutman DH, Montgomery MN, Petros AJ, Padmanabbhan A. Pediatr Crit Care Med. 2010;11(4):451-456.

The authors sought to examine the effects of patient- and transport-related factors on time spent at the referring hospital with the stabilization of critically ill children and the relationship between stabilization time and patient outcomes. The setting for this study was a dedicated regional intensive care retrieval service performing interhospital transports in England.

Analysis was done on prospectively collected data during pediatric intensive care transports over a 2-year period with 2106 interfacility transports. Multivariate and univariate analysis were used on factors relating to patient (age group, diagnostic category, and severity of illness) and transport time (time of referral, response time, and number of major and minor interventions performed). The relationship between stabilization time and patient outcomes in the first 24 hours after intensive care unit admission was studied as well.

The authors found that the time spent undertaking intensive care interventions early in the course of patient illness at the referring hospital does not worsen patient outcome, suggesting that the "scoop and run" model can safely abandon interhospital transport.

DISPARITIES EXIST IN THE EMERGENCY DEPARTMENT EVALUATION OF PEDIATRIC CHEST PAIN

Hambrook, JT, Kimbal TR, Khoury P, Cnota J. Congenit Heart Dis. 2010;5(3):285-291.

The authors state that one of the current major legislative focus areas of the American Academy of Pediatrics is to "significantly reduce or remove all disparities in access to health care and to promote quality culturally effective health care for all infants, children, adolescents, and young adults." Disparities in the emergency department have been documented in chest pain and management, buy not in children.

This study was a secondary analysis of data collected from the National Hospital Ambulatory Medical Care Survey, with the chief complaint being chest pain in those younger than 19 years from 2002 to 2006. The primary outcome variable was any test performed (defined as any combination of complete blood count, electrocardiogram, and/or chest x-ray).

Multivariate analysis revealed that race (P =.03), expected payer (P = -.003), and triage level (P =.009) were significantly and independently associated with the frequency of testing performed. The authors concluded that disparities exist in the emergency department care of pediatric patients with chest pain.