Characteristics of Medically Transported Critically Ill Children with Respiratory Failure in Latin America: Implications for Outcomes

Abstract

Several challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4–36.3).

Keywords

patient transfer - critical illness - mortality - Latin America - hospitals - urban

Authors' Contributions

J.A.S. and F.D. equally contributed to this research as main authors. They were involved in planning and designing the study and participated in all stages of the project. F.D., J.A.S., and M.J.N. conceived the idea. F.D., J.A.B.S., N.M.F., S.G.D., C.C., and P.C. were involved in development of the data extraction questionnaire.

F.D. and P.V.H. analyzed the data and described the results. J.C.J.B., J.A.B.S., M.J.N., R.J., L.M.A., A.W., A.F., A.D., C.C., and S.R.K. contributed to the interpretation of the results.

J.A.S. took the lead in writing the manuscript in consultation with F.D., P.C., and A.D. J.A.B.S., J.C.J.B., A.F., L.M.A., L.P.O., C.Co, C.C., J.M., M.J.N., S.R.K., and S.M. contributed to the discussion in accordance with the results.

All authors were involved in data collection and manuscript preparation and provided critical feedback to the analysis and discussion.

F.D., J.A.S., P.V.H., and S.G.D. supervised the whole project.

F.D., J.A.S., and P.V.H. are the guarantors of and take responsibility for the content of the manuscript. All authors have made substantial contributions to the research, provided final approval of the version to be published, and have agreed to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors have read and approved the manuscript.

Note

Patients admitted to pediatric intensive care units in Latin America for respiratory failure are frequently referred from an outside facility. In this study, we found an independent association between referral from nonurban areas and mortality. This valuable insight can be used to improve quality of care for critically ill children who are transferred from nonurban centers in Latin America.

Collaborators

Argentina: Hospital Durand, Buenos Aires: Fernández A.; Hospital Juan Pablo II, Corrientes: Muzzio S.; Hospital Regional Olga Stucky de Rizzi, Reconquista: Cidral E., Mansur A.

Bolivia: Hospital Materno Infantil Boliviano Japonés, Trinidad: Céspedes Lesczinsky M., Velasco Z.; Hospital Regional San Juan de Dios, Tarija: Casson Rodríguez N.

Chile: Hospital El Carmen, Maipú: Córdova T.; Hospital Regional del Libertador Bernardo O’Higgins, Rancagua: González Moraga M.; Hospital Regional, Antofagasta: Pietroboni Fuster P.; Complejo Asistencial Dr. Víctor Ríos Ruíz, Los Ángeles: Aránguiz Quintanilla D., Sepúlveda J.

Colombia: Clínica Infantil Colsubsidio, Bogotá: Pardo R.

Costa Rica: Hospital Nacional de niños, Dr. Carlos Sáenz Herrera”: Rosales Fernández J., Sanabria S.

Ecuador: Hospital Carlos Andrade Marín, Quito: Guachichulca R., Hospital Inglés, Quito: Farez J.

Uruguay: Hospital Policial, Montevideo: Ferré A., España M.; Círculo Católico, Montevideo: Benech E., Carro M.; Sanatorio Casa de Galicia, Montevideo: Alonso B., Varela F.; Hospital Evangélico, Montevideo: Matrai L., Mislej C.; Sanatorio CAMDEL, Minas: Castro L.; Sanatorio COMECA, Canelones: Caggiano M.J., Talasimov C.; Hospital Salto, Salto: Franco A.

Publication History

Received: 18 August 2020

Accepted: 20 November 2020

Article published online:
20 May 2021

• References

• 1 The World Bank. Latin America & Caribbean. Accessed December 7, 2020 at: https://data.worldbank.org/region/latin-america-and-caribbean
• 2 Campos-Miño S, Sasbón JS, von Dessauer B. [Pediatric intensive care in Latin America]. Med Intensiva 2012; 36 (01) 3-10
• 3 Pearson G, Shann F, Barry P. et al. Should paediatric intensive care be centralised? Trent versus Victoria. Lancet 1997; 349 (9060): 1213-1217
• 4 Cogo PE, Poole D, Codazzi D. et al. Outcome of children admitted to adult intensive care units in Italy between 2003 and 2007. Intensive Care Med 2010; 36 (08) 1403-1409
• 5 Hamrin TH, Berner J, Eksborg S, Radell PJ, Fläring U. Characteristics and outcomes of critically ill children following emergency transport by a specialist paediatric transport team. Acta Paediatr 2016; 105 (11) 1329-1934
• 6 Epstein D, Brill JE. A history of pediatric critical care medicine. Pediatr Res 2005; 58 (05) 987-996
• 7 Lee SH, Schwartz HP, Bigham MT. From the street to the ICU: a review of pediatric emergency medical services and critical care transport. Transl Pediatr 2018; 7 (04) 284-290
• 8 Kawaguchi A, Saunders LD, Yasui Y, DeCaen A. Effects of medical transport on outcomes in children requiring intensive care. J Intensive Care Med 2020; 35 (09) 889-895
• 9 Moynihan K, McSharry B, Reed P, Buckley D. Impact of retrieval, distance traveled, and referral center on outcomes in unplanned admissions to a national PICU. Pediatr Crit Care Med 2016; 17 (02) e34-e42
• 10 Fazio RF, Wheeler DS, Poss WB. Resident training in pediatric critical care transport medicine: a survey of pediatric residency programs. Pediatr Emerg Care 2000; 16 (03) 166-169
• 11 Joyce CN, Giuliano Jr. JS, Gothard MD, Schwartz HP, Bigham MT. Specialty pediatric transport in primary care or urgent care settings. Air Med J 2014; 33 (02) 71-75
• 12 Carrillo B MJ. Transporte interhospitalario pediátrico: Una necesidad creciente de la red asistencial chilena. Rev Chil Pediatr 2014; 85 (02) 144-147
• 13 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] (in Spanish). Med Intensiva 2017; 41 (03) 143-152
• 14 Ibiebele I, Algert CS, Bowen JR, Roberts CL. Pediatric admissions that include intensive care: a population-based study. BMC Health Serv Res 2018; 18 (01) 264
• 15 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
• 16 Straney L, Clements A, Parslow RC. et al; ANZICS Paediatric Study Group and the Paediatric Intensive Care Audit Network. Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care*. Pediatr Crit Care Med 2013; 14 (07) 673-681
• 17 Wood DW, Downes JJ, Lecks HI. A clinical scoring system for the diagnosis of respiratory failure. Preliminary report on childhood status asthmaticus. Am J Dis Child 1972; 123 (03) 227-228
• 18 Ramnarayan P, Thiru K, Parslow RC, Harrison DA, Draper ES, Rowan KM. Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study. Lancet 2010; 376 (9742): 698-704
• 19 Ramnarayan P, Dimitriades K, Freeburn L. 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 (06) e300-e311
• 20 Odetola FO, Rosenberg AL, Davis MM, Clark SJ, Dechert RE, Shanley TP. Do outcomes vary according to the source of admission to the pediatric intensive care unit?. Pediatr Crit Care Med 2008; 9 (01) 20-25
• 21 Odetola FO, Clark SJ, Gurney JG, Dechert RE, Shanley TP, Freed GL. Effect of interhospital transfer on resource utilization and outcomes at a tertiary pediatric intensive care unit. J Crit Care 2009; 24 (03) 379-386
• 22 Pan-American Health Organization, World Health Organization. Neonatal Transport in developing country settings: a systematic review. Accessed December 7, 2020 at: https://iris.paho.org/bitstream/handle/10665.2/31317/9789275319178-eng.pdf?sequence=5&isAllowed=y
• 23 Araújo BF, Zatti H, Oliveira Filho PF. et al. Effect of place of birth and transport on morbidity and mortality of preterm newborns. J Pediatr (Rio J) 2011; 87 (03) 257-262
• 24 Ward JL, Viner RM. The impact of income inequality and national wealth on child and adolescent mortality in low and middle-income countries. BMC Public Health 2017; 17 (01) 429
• 25 Abramo L, Cecchini S, Ullmann HH. [Addressing health inequalities in Latin America: the role of social protection] (in Spanish). Cien Saude Colet 2020; 25 (05) 1587-1598
• 26 Garcia J. Urban–rural differentials in Latin American infant mortality. Demogr Res 2020; 42 (08) 203-244
• 27 Van de Poel E, O'Donnell O, Van Doorslaer E. What explains the rural-urban gap in infant mortality: household or community characteristics?. Demography 2009; 46 (04) 827-850
• 28 González F, Alfaro T, Horna-Campos O. [Infant mortality in the metropolitan region, Chile 2005-2014] (in Spanish). Rev Chil Pediatr 2020; 91 (01) 34-45
• 29 Meyer MT, Mikhailov TA, Kuhn EM, Collins MM, Scanlon MC. Pediatric specialty transport teams are not associated with decreased 48-hour pediatric intensive care unit mortality: a propensity analysis of the VPS, LLC database. Air Med J 2016; 35 (02) 73-78
• 30 Vos GD, Nissen AC. H M Nieman F, et al. Comparison of interhospital pediatric intensive care transport accompanied by a referring specialist or a specialist retrieval team. Intensive Care Med 2004; 30 (02) 302-308
• 31 Limprayoon K, Sonjaipanich S, Susiva C. Transportation of critically ill patient to Pediatric Intensive Care Unit, Siriraj Hospital. J Med Assoc Thai 2005; 88 (Suppl. 08) S86-S91
• 32 Carcillo JA, Kuch BA, Han YY. et al. Mortality and functional morbidity after use of PALS/APLS by community physicians. Pediatrics 2009; 124 (02) 500-508
• 33 Steffen KM, Noje C, Costabile PM. et al. Pediatric transport triage: development and assessment of an objective tool to guide transport planning. Pediatr Emerg Care 2020; 36 (05) 240-247
• 34 Cassiani SHB, Wilson LL, Mikael SSE. et al. The situation of nursing education in Latin America and the Caribbean towards universal health. Rev Lat Am Enfermagem 2017; 25: e2913
• 35 Orr RA, Felmet KA, Han Y. et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics 2009; 124 (01) 40-48
• 36 Transport resources. In: Insoft RM, Schwartz HP. eds. Guidelines for Air & Ground Transport of Neonatal and Pediatric Patients Manual. 4th ed.. Washington, DC: American Academy of Pediatrics; 2016: 498
• 37 Woodward GA, Insoft RM, Pearson-Shaver AL. et al. The state of pediatric interfacility transport: Consensus of the Second National Pediatric and Neonatal Interfacility Transport Medicine Leadership Conference. Pediatr Emerg Care 2002; 18 (01) 38-43
• 38 King BR, Foster RL, Woodward GA, McCans K. Procedures performed by pediatric transport nurses: how “advanced” is the practice?. Pediatr Emerg Care 2001; 17 (06) 410-413
• 39 Pan-American Health Organization, World Health Organization. Perspectives and contributions of nursing to promote universal health. Accessed December 7, 2020 at: https://iris.paho.org/handle/10665.2/52121