From the Children's Acute Transport Service (CATS), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
Pediatr Emerg Care. 2023 Mar 1;39(3):173-178. doi: 10.1097/PEC.0000000000002844. Epub 2022 Sep 9.
Current guidance in the United Kingdom recommends that children requiring emergency neurosurgical intervention should be transported by referring hospital (RH) teams. We aimed to compare transports performed by RH teams and by specialized pediatric critical care transport (PCCTs) teams in terms of timings and patient outcomes.
We conducted a retrospective analysis over a 5-year period of children admitted from an external hospital to the pediatric intensive care unit at a pediatric neurosurgical center and receiving emergency neurosurgery within 24 hours of admission. Data were collected on RH characteristics, patient demographics, clinical status, transfer method (RH or PCCT team), timings (arrival at neurosurgical center, neurosurgical procedure), and clinical outcomes (length of stay and mortality). Univariate analysis was used to compare patient characteristics, times, and outcomes between RH and PCCT team transfers. Survival analysis was performed to analyze arrival time by transfer modality.
During the study period, 75 children with acute neurosurgical emergencies were transferred. Median age was 6.7 years (interquartile range, 1.8-10.7), and 63% had nontraumatic diagnoses. The commonest mode of transfer was by RH teams after initial referral to a PCCT team (53.3%). The median distance was greatest for transfers by RH teams (14 km). Overall median arrival time was 5 hours (interquartile range, 3.6-7.4) with no significant difference between groups ( P = 0.3). Median length of pediatric intensive care unit stay and mortality did not differ between groups.
Specialist critical care transport teams are involved in one third of transfers of children with acute neurosurgical emergencies. While the overriding priority is timely transfer, a tailored approach to the use of PCCTs may be appropriate particularly for children presenting to hospitals nearer to neurosurgical centers.
目前英国的指南建议，需要紧急神经外科干预的儿童应由转介医院（RH）团队进行转运。我们旨在比较 RH 团队和专门的儿科重症监护转运（PCCT）团队在时间和患者结局方面的转运。
我们对 5 年来从外部医院转入儿科神经外科中心儿科重症监护病房并在入院后 24 小时内接受紧急神经外科手术的儿童进行了回顾性分析。收集 RH 特征、患者人口统计学、临床状况、转运用途（RH 或 PCCT 团队）、时间（到达神经外科中心、神经外科手术）和临床结局（住院时间和死亡率）的数据。使用单变量分析比较 RH 和 PCCT 团队转运的患者特征、时间和结局。使用生存分析来分析按转运用途到达时间。
在研究期间，75 名患有急性神经外科急症的儿童被转院。中位年龄为 6.7 岁（四分位距，1.8-10.7），63%的患者为非创伤性诊断。最常见的转运用途是在最初转介给 PCCT 团队后由 RH 团队进行（53.3%）。RH 团队转运用途的中位数距离最大（14 公里）。总体中位到达时间为 5 小时（四分位距，3.6-7.4），两组间无显著差异（P=0.3）。两组患儿在儿科重症监护病房的中位住院时间和死亡率无差异。
专门的重症监护转运团队参与了三分之一的急性神经外科急症儿童的转运。虽然首要任务是及时转运，但可能需要针对 PCCT 的使用制定针对性方法，特别是对于那些接近神经外科中心的医院就诊的儿童。
