Children's Acute Transport Service, Great Ormond Street Hospital, London, UK.
Lancet. 2010 Aug 28;376(9742):698-704. doi: 10.1016/S0140-6736(10)61113-0. Epub 2010 Aug 11.
Intensive care services for children have undergone substantial centralisation in the UK. Along with the establishment of regional paediatric intensive care units (PICUs), specialist retrieval teams were set up to transport critically ill children from other hospitals. We studied the outcome of children transferred from local hospitals to PICUs.
We analysed data that were gathered for a cohort of children (<or=16 years) admitted consecutively to 29 PICUs in England and Wales during 4 years (Jan 1, 2005, to Dec 31, 2008). We compared unplanned admissions from wards within the same hospital as the PICU and from other hospitals; interhospital transfers by non-specialist and specialist retrieval teams; and patients transferred to their nearest PICU and those who were not. Primary outcome measures were mortality rate in PICU and length of stay in PICU. We analysed data by use of logistic regression analysis.
There were 57 997 admissions to PICUs during the study. Nearly half of unplanned admissions (17 649 [53%] of 33 492) were from other hospitals. Although children admitted from other hospitals were younger (median 10 months [IQR 1-55] vs 18 months [3-85]), sicker at admission (median predicted risk of mortality 6% [4-10] vs 4% [2-7]), stayed longer in PICUs (75 h [33-153] vs 43 h [18-116]), and had higher crude mortality rates (1384 [8%] of 17 649 vs 996 [6%] of 15 843; odds ratio 1.27, 95% CI 1.16-1.38), the risk-adjusted mortality rate in PICUs was lower than among children admitted from within the same hospital (0.65, 0.53-0.80). In a multivariable analysis, use of a specialist retrieval team for transfer was associated with improved survival (0.58, 0.39-0.87).
These findings support the policy of combining centralisation of intensive care services for children with transfer by specialist retrieval teams.
National Clinical Audit and Patient Outcomes Programme through Healthcare Quality Improvement Partnership, Health Commission Wales Specialised Services, National Health Service (NHS) Lothian and National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, and the Pan Thames PICU Commissioning Consortium.
英国的儿童重症监护服务已经进行了大规模的集中化。随着区域儿科重症监护病房（PICU）的建立，专门的救援团队也成立起来，负责从其他医院转运重病儿童。我们研究了从当地医院转至 PICU 的儿童的转归。
我们分析了在英格兰和威尔士的 29 个 PICU 连续收治的一组（<或=16 岁）儿童的数据（2005 年 1 月 1 日至 2008 年 12 月 31 日）。我们比较了同一 PICU 院内病房和其他医院的非计划性入院；非专业和专业救援团队的医院间转院；以及转至最近的 PICU 和未转至最近 PICU 的患者。主要转归指标为 PICU 死亡率和 PICU 住院时间。我们使用逻辑回归分析来分析数据。
研究期间共有 57997 名儿童入住 PICU。近一半（33492 例中的 17649 例[53%]）非计划性入院来自其他医院。虽然从其他医院转入的儿童年龄较小（中位数 10 个月[IQR 1-55] vs 18 个月[3-85]），入院时病情更重（中位预测死亡率风险 6%[4-10] vs 4%[2-7]），在 PICU 住院时间更长（75 h[33-153] vs 43 h[18-116]），且死亡率较高（17649 例中的 1384 例[8%] vs 15843 例中的 996 例[6%]；比值比 1.27，95%CI 1.16-1.38），但风险调整后的 PICU 死亡率低于同一医院入院的儿童（0.65，0.53-0.80）。多变量分析显示，使用专业救援团队转运与生存率提高相关（0.58，0.39-0.87）。
这些发现支持将儿童重症监护服务集中化与专业救援团队转运相结合的政策。
国家临床审计和患者结局计划通过医疗保健质量改进伙伴关系、威尔士卫生委员会专门服务、苏格兰国民健康服务 NHS 洛锡安区和国家服务司、贝尔法斯特皇家儿童医院和泛泰晤士 PICU 委托联盟提供资金。
