Decision-making for children requiring interhospital transport: assessment of a novel triage tool

2021 ◽  
pp. archdischild-2019-318634
Author(s):  
Anthony Slater ◽  
Deanne Crosbie ◽  
Dionne Essenstam ◽  
Brett Hoggard ◽  
Paul Holmes ◽  
...  
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Negative Predictive Value ◽  
Critically Ill ◽  
Predictive Value ◽  
Critically Ill Children ◽  
Intensive Care Admission ◽  
Transport Services ◽  
Interhospital Transport ◽  
Retrieval Team

ObjectiveThe 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.DesignProspective observational study.SettingRegional paediatric retrieval and transport services.PatientsData were collected for 1815 children referred consecutively for interhospital transport from 87 hospitals in Queensland and northern New South Wales.InterventionImplementation of the Queensland Paediatric Transport Triage Tool.Main outcome measuresAccuracy 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.ResultsA 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%).ConclusionsThe 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.

scholarly journals Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialized retrieval team

Critical Care ◽  
2011 ◽  
Vol 15 (1) ◽  
pp. R75 ◽  
Author(s):  
Janke S Wiegersma ◽  
Joep M Droogh ◽  
Jan G Zijlstra ◽  
Janneke Fokkema ◽  
Jack JM Ligtenberg
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Interhospital Transport ◽  
Mobile Intensive Care Unit ◽  
Retrieval Team

scholarly journals Serum NGAL in Critically Ill Children in ICU from a Single Center in Egypt

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Doaa Mohammed Youssef ◽  
Asmaa Mohammed Esh ◽  
Ebthag Helmy Hassan ◽  
Tahia Mohammed Ahmed
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Critically Ill ◽  
Predictive Value ◽  
Characteristic Curve ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Control Group ◽  
Mortality And Morbidity ◽  
Neutrophil Gelatinase Associated Lipocalin

Introduction. The mortality and morbidity associated with acute kidney injury (AKI), unfortunately, remain unacceptably high. We aimed to detect the extent of serum neutrophil gelatinase-associated lipocalin (NGAL) to early detect AKI in critically ill children. Subjects and Methods. This is a case control study. It included 75 subjects that include 15 as controls and 60 critically ill children. Patients were further subdivided according to RIFLE criteria into two other categories: patients who developed AKI and patients who did not develop AKI. Serum NGAL assayed on admission and after 3 days. Results. There was significant increase in the level of NGAL among patients group when compared with control group. Also, 21.7% of children admitted to PICU developed AKI from which 8.3% needed dialysis. The receiver operating characteristic curve of NGAL at day 0 revealed AUC of 0.63 with 95% CI of 0.50–0.77. At a cutoff value of 89.5 ng/mL, the sensitivity of NGAL was 84.6%, while specifcity was 59.6%, positive predictive value was 36.7%, negative predictive value was 68.4%, and accuracy was 93.3% in diagnosis of AKI. Conclusion. We found that NGAL acts as a sensitive marker rather than a specific one for AKI. At the same time, it presents as a negative predictive value more valuable than being a positive predictive value in detecting AKI.

Parental Decision-Making in the Pediatric Intensive Care Unit: An Integrative Review

2021 ◽  
pp. 107484072097586
Author(s):  
Jesse Wool ◽  
Sharon Y. Irving ◽  
Salimah H. Meghani ◽  
Connie M. Ulrich
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Integrative Review ◽  
Empirical Literature ◽  
Critically Ill Children ◽  
Serious Illness

Parents are commonly responsible for making health care decisions for their seriously ill children in the pediatric intensive care unit (PICU); however, the factors influencing their decisions may vary. This integrative review examined the empirical literature between 2013 and 2018 to understand factors pertaining to parents’ decision-making about serious illness care of their children in the PICU. Seventeen studies met the inclusion criteria with three key findings. First, parent–clinician communication in the PICU is critical; second, most parents want to be the final decision-maker for their critically ill child; and third, parents’ emotions, support systems, and the child’s clinical status impact decision-making. Parental perspectives are important to consider when discussing serious illness care decisions for critically ill children. Further inquiry is needed into how the parent–clinician encounter impacts the decision-making process and subsequent outcomes in this population.

Evaluation of a Portable Infrared End-Tidal Carbon Dioxide Monitor During Pediatric Interhospital Transport

PEDIATRICS ◽  
1995 ◽  
Vol 95 (6) ◽  
pp. 875-878
Author(s):  
Mananda S. Bhende ◽  
Valerie A. Karr ◽  
Drew C. Wiltsie ◽  
Richard A. Orr
Keyword(s):  
Carbon Dioxide ◽  
Critically Ill ◽  
Predictive Value ◽  
Tertiary Care ◽  
False Negative ◽  
Critically Ill Children ◽  
Arterial Blood ◽  
Interhospital Transport ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

Purpose. Critically ill children often require endotracheal intubation before transport to a tertiary care center. Correct endotracheal tube (ETT) placement (trachea versus esophagus) and maintenance during transport are of the utmost importance. We evaluated a portable, qualitative, infrared end-tidal carbon dioxide monitor during transport of critically ill children. Methods. Fifty patients, ages 1 day to 19 years (median, 1 year), weighing 1.6 to 70 kg (median, 10 kg) who were intubated and transported by ground ambulance (n = 25) or rotorcraft (n = 25) were enrolled. ETT position was confirmed by physical examination, arterial blood gas or pulse oximetry, and sometimes by a chest radiograph. The instrument was attached, and readings were obtained before and during transport by transport nurses or respiratory therapists who also completed a brief questionnaire about the monitor. A moving bar indicator with a light-emitting diode display on the instrument indicates the presence of expired carbon dioxide. Results. All three esophageal tube positions and 48 of 50 tracheal tube positions were correctly identified (sensitivity, 96%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 60%). There were two false-negative results: in one case, there was instrument malfunction because of blood backing up into the tubing because of traumatic intubation, and in the second case, the patient had a chest tube that was leaking air. The device was evaluated as "too large" (30 of 50), "hard to secure" (25 of 50), and "not convenient" (29 of 50). Tube kinking was a problem (n = 7) when used in small infants in isolettes. The instrument was considered helpful in assuring ETT position when clinical evaluation was not possible because of noisy conditions. Conclusions. We conclude that this carbon dioxide monitor was useful during transport of critically ill children in confirming ETT position. Further improvements in this noninvasive technology might be helpful in making the device more practical for use during interhospital transport.

Decision Making and End-of-Life Care in Critically Ill Children

2000 ◽  
Vol 16 (1_suppl) ◽  
pp. S45-S52 ◽  
Author(s):  
Christian Masri ◽  
Catherine Ann Farrell ◽  
Jacques Lacroix ◽  
Graeme Rocker ◽  
Sam D. Shemie
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Intensive Care ◽  
End Of Life ◽  
Critically Ill ◽  
End Of Life Care ◽  
Critically Ill Children ◽  
Life Care ◽  
End Of Life Decisions ◽  
Life Therapy

Objectives 1) To comment on the medical literature on decision making regarding end-of-life therapy, 2) to analyze the data on disagreement about such therapy, including palliative care, and withholding and withdrawal practices for critically ill children in the pediatric intensive care unit (PICU), and 3) to make some general recommendations. Data Sources and Study Selection All papers published in peer-reviewed journals, and all chapters on end-of-life therapy, or on conflict between parents and caregivers about end-of-life decisions in the PICU were retrieved. Results We found three case series, three systematic descriptive studies, two qualitative studies, four surveys, and many legal opinions, editorials, reviews, guidelines, and book chapters. The main determinants of end-of-life decisions are the child's age, premorbid cognitive condition and functional status, pain or discomfort, probability of survival, and quality of life. Risk factors in persistent conflict between parents and caregivers about end-of-life care include a grave underlying condition or an unexpected and severe event. Conclusion Making decisions about end-of-life care is a frequent event in the PICU. Children may need both intensive care and palliative care concurrently at different stages of their illness. Disagreements are more likely to be resolved if the root cause of the conflict is better understood.

scholarly journals Epidemiology of Blood Culture Utilization in a Cohort of Critically Ill Children

2019 ◽  
Vol 08 (03) ◽  
pp. 144-147
Author(s):  
Christine Anh-Thu Tran ◽  
Jenna Verena Zschaebitz ◽  
Michael Campbell Spaeder
Keyword(s):  
Decision Making ◽  
Blood Culture ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Critically Ill ◽  
Clinical Status ◽  
Blood Cultures ◽  
Systemic Inflammatory Response ◽  
Critically Ill Children ◽  
Culture Acquisition

AbstractBlood culture acquisition is integral in the assessment of patients with sepsis, though there exists a lack of clarity relating to clinical states that warrant acquisition. We investigated the clinical status of critically ill children in the timeframe proximate to acquisition of blood cultures. The associated rates of systemic inflammatory response syndrome (72%) and sepsis (57%) with blood culture acquisition were relatively low suggesting a potential overutilization of blood cultures. Efforts are needed to improve decision making at the time that acquisition of blood cultures is under consideration and promote percutaneous blood draws over indwelling lines.

scholarly journals Pediatric Multi-Organ Dysfunction Syndrome: Analysis by an Untargeted “Shotgun” Lipidomic Approach Reveals Low-Abundance Plasma Phospholipids and Dynamic Recovery over 8-Day Period, a Single-Center Observational Study

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 774
Author(s):  
Mara L. Leimanis-Laurens ◽  
Karen Ferguson ◽  
Emily Wolfrum ◽  
Brian Boville ◽  
Dominic Sanfilippo ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Intensive Care ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Lipid Profiles ◽  
Critically Ill Children ◽  
P Value ◽  
Time Points ◽  
Logistic Organ Dysfunction ◽  
Multi Organ Dysfunction Syndrome

Lipids are molecules involved in metabolism and inflammation. This study investigates the plasma lipidome for markers of severity and nutritional status in critically ill children. Children with multi-organ dysfunction syndrome (MODS) (n = 24) are analyzed at three time-points and cross-referenced to sedation controls (n = 4) for a total of N = 28. Eight of the patients with MODS, needed veno-arterial extracorporeal membrane oxygenation (VA ECMO) support to survive. Blood plasma lipid profiles are quantified by nano-electrospray (nESI), direct infusion high resolution/accurate mass spectrometry (MS), and tandem mass spectrometry (MS/MS), and compared to nutritional profiles and pediatric logistic organ dysfunction (PELOD) scores. Our results show that PELOD scores were not significantly different between MODS and ECMO cases across time-points (p = 0.66). Lipid profiling provides stratification between sedation controls and all MODS patients for total lysophosphatidylserine (lysoPS) (p-value = 0.004), total phosphatidylserine (PS) (p-value = 0.015), and total ether-linked phosphatidylethanolamine (ether-PE) (p-value = 0.03) after adjusting for sex and age. Nutrition intake over time did not correlate with changes in lipid profiles, as measured by caloric and protein intake. Lipid measurement in the intensive care environment shows dynamic changes over an 8-day pediatric intensive care unit (PICU) course, suggesting novel metabolic indicators for defining critically ill children.

scholarly journals UK consultants’ experiences of the decision-making process around referral to intensive care: an interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044752
Author(s):  
Kaja Heidenreich ◽  
Anne-Marie Slowther ◽  
Frances Griffiths ◽  
Anders Bremer ◽  
Mia Svantesson
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Moral Responsibility ◽  
Critically Ill ◽  
Interpersonal Relationships ◽  
Qualitative Interviews ◽  
Working Environment ◽  
Critically Ill Patient ◽  
Decision Making Process ◽  
Moral Duties

ObjectiveThe decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these issues in practice. The aim of this study was to describe and understand consultants’ experiences of the decision-making process around referral to intensive care.DesignQualitative interviews were analysed according to a phenomenological hermeneutical method.Setting and participantsConsultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.ResultsIn the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient’s situation, and responding to mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.ConclusionThe findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. For this reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.

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