Outcome of children transported for pediatric intensive care to a tertiary care setting in Sri Lanka

Introduction: Patient transport remains a necessary facet of today’s health care environment and transport conditions bear a major impact on the outcome. There is a recent move in Sri Lanka to establish retrieval teams. Thus, identifying problems faced by the present system will be of utmost importance in development of transport teams. 

Objective: To evaluate the present system of transportation of sick children to the Medical Intensive Care Unit (MICU), Lady Ridgeway Hospital for Children (LRH), Colombo.

Method: A prospective, descriptive, observational study of transferred patients was conducted at the MICU LRH, Colombo. All children admitted to MICU from 1^st March 2014 to 1^st June 2014 were included in the study. Data was collected using a self-administered questionnaire. The Wilcoxon significant rank test and the Chi squared test were utilized in statistical analysis.

Results: There were 200 patients comprising 105 (52.5%) out-of-hospital transfers and 95 (47.5%) in-hospital transfers. Of the admissions, 72% were live discharges while 28% expired; 42.5% of transfers were from the Colombo district. Pneumonia was the commonest diagnosis, occurring in 38.5%. The pre-transfer Paediatric Risk Mortality (PRISM) scores had a median of 12, mean of 13.7±7.8 and Q1-8 to Q3-18. The 12 hour PRISM scores, after excluding patients with PRISM scores of less than 5, showed a median of 14, mean of 18.5±11.7 and a ‘p’ value 0.0002. There was no outcome difference between in-hospital vs out-of-hospital transfers based on the Chi squared test. A written summary was available only in 61 (30.5%) patients. 

Conclusion: A rise in the PRISM score after transfer indicates that the patients had deteriorated during the transfer and transfer conditions need to be improved.

(Key words: Paediatric transport, PRISM score)

DOI: http://dx.doi.org/10.4038/sljch.v45i2.7998