Does any program use an early warning systems such as CHEWS or PEWS on transports? If so, how often do you score them?
How does your score related to admit units (floor vs ICU)?
Thanks for any help. – NO conversation here
2015 TRAP (Transport Risk Assessment in Pediatrics) Score Predicts the Clinical Course of Pediatric Patients Admitted to the Intensive Care Unit.
Rosa L. Haddock-de-Jesús, MD1, Anabel Puig-Ramos, PHD, FCCP1, Milagros Martin-de-Pumarejo, MD, FAAP2, Christopher L. Ayala-Griffin1, Ana R. Hernández-Javier1 and Gilberto Puig, MD, FAAP1, (1)UPR-School of Medicine, Dept. of Pediatrics- Critical Care Medicine Section, San Juan, PR, (2)UPR-School of Medicine, Pediatric Emergency Medicine Section, San Juan, PR
Purpose: The objectives of this study were to: (1) evaluate the effect and relationship of transport time since referral to a tertiary pediatric ICU on patient’s clinical outcome and (2) study relationship between the TRAP score (Transport Risk Assessment in Pediatrics Score – Kandil, et. al.), the PRISM (Pediatric Risk of Mortality) score and patients’ clinical outcome in PICU.
Methods: This study is a prospective observational cohort study including patients from 0-21 years old admitted to a tertiary pediatric intensive care unit in Puerto Rico from August – March 2015. Information prior to transport to the PICU was collected via phone call from the referring physician and include vital signs and neurological status (GCS) along with time of referral. Once the patient arrived to the PICU, time of arrival was recorded and a PRISM III score was calculated. Outcomes were measured as length of stay at PICU and death. Data was expressed as means ± SEM and medians and minimum and maximum. A Mann-Whitney test and logistic regression was used to analyze data.
Results: A total of 51 patients met inclusion criteria, 49% females, 51% males with a mean age of 89.4 ± 11.1 months. Overall mortality rate was 5.9%. Mean length of stay at PICU was 5.8 ± 0.7 days. There was a mean PRISM score of 5.7 ± 1 and a mean TRAP Score of 3.2 ±0.3. The mean total time between referral and arrival time to PICU was 291 ± 29.2 minutes (mean of 4.8 hours). There was no association between mortality and PRISM score. There was no association between total time of transportation and PICU length of stay and mortality. A univariate logistic regression showed that mortality was associated with a high TRAP score (OR 2.7 [95% CI 1.2 – 5.9], p = 0.02). We found that that patients with a TRAP score greater than 5 were associated with a prolonged length of stay at the pediatric ICU.
Conclusion: This study demonstrated that a high TRAP score was associated with prolonged length of stay and mortality at the pediatric ICU. This study showed that this score is also useful to predict the clinical course of patients admitted to the ICU and could be used to determine the level of care needed by patients prior to transportation. This study will be continued for a total of one year. However, the results shown so far support the need of better objective tools used by physicians and healthcare professionals involved in patient care prior to transportation to any other place or institution to make correct choices about patient care and safety. A centralized dispatch system should decrease the timetable final disposition of our patients improving outcomes.
2012 The use of a modified pediatric early warning score to assess stability of pediatric patients during transport.
Petrillo-Albarano T1, Stockwell J, Leong T, Hebbar K. Abstract
OBJECTIVE:Pediatric early warning scores (PEWSs) have been used effectively in limited patient care areas. Children’s Transport, at Children’s Healthcare of Atlanta, transports approximately 5000 children annually. In an effort to consistently assess patient acuity and the impact of our team’s interventions, we instituted a modified “transport PEWS” (TPEWS).
METHODS:The existing PEWS was modified to reflect the transport environment. A retrospective chart review was conducted of 100 consecutive children transported by Children’s Transport in March 2009. Transport PEWS given during triage by the dispatch center (TPEWStri), TPEWS calculated at referring facility by the team (TPEWSref), and final TPEWS at the accepting institution (TPEWSacc) were compared.
RESULTS:Eighty-six patients were transported by ground. The median age was 50.4 months. Sixty patients (60%) received some intervention from the transport team. Median TPEWSref was 3 (0-9) upon initial assessment, and TPEWSacc was 2 (0-9) on arrival at the accepting facility (P = 0.0001). Seventy-three percent (73/100) of patients were transported to the emergency room; 15 (15%) of 100 to the general inpatient area, and 12 (12%) of 100 to the intensive care unit. In addition, a triage TPEWS (TPEWStri) was calculated from information given from the referring facility in 59 of the 100 patients. A significant difference in TPEWStri and TPEWSref was noted (P = 0.0001).
CONCLUSIONS: In this cohort of pediatric transport patients, TPEWS appears to be a helpful additional assessment tool. Transport PEWS may function as a tool for assessing severity of illness, hence optimizing transport dispatch and patient disposition.
2012 Transport disposition using the Transport Risk Assessment in Pediatrics (TRAP) score.
Sarah B. Kandil, MD,1 Heather A. (Schmenk) Sanford, RN, BSN, CCRN,2 Veronika Northrup, MPH,3 Michael Theodore Bigham, MD,4 and John Sebastian Giuliano, Jr., MD1 Free PMC article
Background: Determining appropriate disposition for referred pediatric patients is difficult since it relies primarily on a telephone description of the patient. In this study, we evaluate the Transport Risk Assessment in Pediatrics (TRAP) score’s ability to assist in appropriate placement of these patients. This novel tool is derived from physiologic variables.
Objectives: To determine the feasibility of calculating a TRAP score and whether a higher score correlates with Pediatric Intensive Care Unit (PICU) admission.
Methods: We performed an observational study of pediatric patients transported by a specialized team to a tertiary care center and the feasibility of implementing the TRAP tool. Patients were eligible if transported by the pediatric specialty transport team for direct admission to the children’s hospital. The TRAP score was obtained either through chart review of transport team’s initial assessment or real-team by the transport team.
Results: A total of 269 patients were identified with 238 patients included in the study Using logistic regression, higher TRAP scores were associated with PICU admission (OR 1.40, p <0.001). Patients with a higher score were also less likely to leave the PICU within 24 hours (OR 0.79, p <0.001).
Conclusion: The TRAP score is a novel objective pediatric transport assessment tool where an elevated score is associated with PICU admission for greater than 24 hours. This score may assist with the triage decisions for transported pediatric patients.
Pediatric Early Warning System (PEWS): A useful pediatric transport triage tool?