WIP 39 - Relationship Between Time and Distance on Illness Severity and Outcomes of Critically Ill Children Transferred to a Tertiary Pediatric Intensive Care Unit

Publication Number: WIP 39.7554

Courtney Massey, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Michael Garbe, Oklahoma Childrens Hospital at OU Health, Oklahoma City, OK, United States; Xiaolan Liao, University of Oklahoma College of Medicine, Oklahoma City, OK, United States; Andrew Gormley, OUHSC, Oklahoma City, OK, United States; manzilat akande, Oklahoma Childrens Hospital at OU Health, oklahoma city, OK, United States

Background: Regionalization of care has been associated with delayed access and adverse outcomes for critically ill children who are transferred to a tertiary pediatric intensive care unit (PICU). For non-critical transfers, outcomes related to regionalization have varied by illness type. It is unclear if the impact of transport time and distance on outcomes varies by type of critical illness.

Objective: To examine the relationship between time and distance to a tertiary PICU and outcomes of critical illness and identify conditions for which outcomes may be differentially impacted by these factors.

Design/Methods: Retrospective, single-center cohort study of 1600 PICU admissions (2014-2021) for children < 18 years of age who were transferred from a referring hospital. IRB approval was obtained. Data are from the Virtual Pediatric Systems (VPS) database and hospital transfer center. Study outcomes are illness severity scores (PIM2 and PRISM 3), PICU mortality, and length of stay. Referring hospital locations were geocoded to determine the distance using geospatial techniques to account for the mode of transport. The transfer time was calculated as the interval between transfer initiation and PICU arrival. For preliminary analysis, separate linear regression models for time and distance were created to analyze the association with Illness severity scores for the overall cohort and VPS primary diagnosis categories. Final regression models will assess the relationship between study outcomes and adjust for demographic, clinical, and referring hospital factors (trauma level and rurality).
Preliminary results are as follows: most transfers were for males, infants and teenagers, occurred during PM hours, on a weekday, from urban areas and disadvantaged neighborhoods. Age, sex, race/ethnicity, primary diagnosis category, and hospital rurality were associated with illness severity, while time and day of transfer were not. Of the VPS categories, there was a significant association between 1) distance and PRISM 3 scores for respiratory and 2) travel time and PIM 2 scores for infections.