Utilizing Pediatric Scoring Systems to Predict Disposition During Interfacility Transport

Abstract

Objective: Determining care disposition for pediatric patients during interfacility transport is often challenging. Severity of illness scoring can assist with this process. The purpose of this retrospective study was to compare currently utilized scoring systems and their ability to reliably match pediatric transport patients’ severity of illness with the level of care necessary. Methods: The retrospective transport registry review for our region included 209 patients <18 years, transported between 2015 and 2016 and admitted to tertiary care. The Pediatric RISk of Mortality III (PRISM III); Canadian Pediatric Triage and Acuity Scale (PedCTAS); Transport Pediatric Early Warning Scores (TPEWS); and Transport Risk Assessment in Pediatrics (TRAP) scores were calculated. Descriptive statistics and binomial logistic regression were utilized to compare the scoring tools. Interrater reliability was calculated using kappa statistics. All analyses were computed using IBM SPSS Statistics for Windows, version 24. Results: Patients were more likely to be admitted to pediatric intensive care unit (PICU) with PedCTAS = 1 (odds ratio [OR] = 37.2; 95% confidence interval [CI], 12.4, 111.4; p < 0.0001), TPEWS = 3 in one category or total score ≥6 (OR = 42.2; 95% CI, 17.0, 104.9; p < 0.0001), and TRAP ≥4 (OR = 7.2; 95% CI, 3.8, 13.5; p < 0.0001). PRISM scores were not predictive for PICU admissions. Conclusion: Elevated PedCTAS, TPEWS, and TRAP scores are strongly associated with PICU admission within the interfacility transport setting.

Key words:

• critical illness
• patient acuity
• pediatrics
• transportation of patients
• triage