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Decision-making for children requiring interhospital transport: assessment of a novel triage tool
  1. Anthony Slater1,2,
  2. Deanne Crosbie3,
  3. Dionne Essenstam4,
  4. Brett Hoggard5,
  5. Paul Holmes1,
  6. Julie McEniery1,2,
  7. Michelle Thompson4
  1. 1Children’s Health Queensland Retrieval Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
  2. 2School of Clinical Medicine, The University of Queensland, South Brisbane, Queensland, Australia
  3. 3Telehealth Emergency Management Support Unit, Aeromedical Retrieval and Disaster Management Branch, Queensland Health, Kedron, Queensland, Australia
  4. 4Children’s Advice and Transport Coordination Hub, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
  5. 5Retrieval Service Queensland, Aeromedical Retrieval and Disaster Management Branch, Queensland Health, Kedron, Queensland, Australia
  1. Correspondence to Dr Anthony Slater, Children’s Health Queensland Retrieval Service, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Anthony.Slater{at}health.qld.gov.au

Abstract

Objective The use of specialist retrieval teams to transport critically ill children is associated with reduced risk-adjusted mortality and morbidity; however, there is a paucity of data to guide decision-making related to retrieval team activation. We aimed to assess the accuracy of a novel triage tool designed to identify critically ill children at the time of referral for interhospital transport.

Design Prospective observational study.

Setting Regional paediatric retrieval and transport services.

Patients Data were collected for 1815 children referred consecutively for interhospital transport from 87 hospitals in Queensland and northern New South Wales.

Intervention Implementation of the Queensland Paediatric Transport Triage Tool.

Main outcome measures Accuracy was assessed by calculating the sensitivity, specificity and negative predictive value for predicting transport by a retrieval team, or admission to intensive care following transport.

Results A total of 574 (32%) children were transported with a retrieval team. Prediction of retrieval (95% CIs): sensitivity 96.9% (95% CI 95.1% to 98.1%), specificity 91.4% (95% CI 89.7% to 92.9%), negative predictive value 98.4% (95% CI 97.5% to 99.1%). There were 412 (23%) children admitted to intensive care following transport. Prediction of intensive care admission: sensitivity 96.8% (95% CI 94.7% to 98.3%), specificity 81.2% (95% CI 79.0% to 83.2%), negative predictive value 98.9% (95% CI 98.1% to 99.4%).

Conclusions The triage tool predicted the need for retrieval or intensive care admission with high sensitivity and specificity. The high negative predictive value indicates that, in our setting, children categorised as acutely ill rather than critically ill are generally suitable for interhospital transport without a retrieval team.

  • physiology
  • epidemiology

Data availability statement

Data are available upon reasonable request. Deidentified data and Stata code used for the analysis may be obtained by contacting the corresponding author (AS), subject to appropriate ethical and research governance approvals.

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Data availability statement

Data are available upon reasonable request. Deidentified data and Stata code used for the analysis may be obtained by contacting the corresponding author (AS), subject to appropriate ethical and research governance approvals.

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Footnotes

  • Contributors AS, DE, BH and DC conceptualised the triage tool. DE project managed the implementation of the tool and managed the database with oversight by JME. PH contributed to implementation. AS analysed the data. AS, MT and JME contributed to data interpretation and manuscript preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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