Hospital survival upon discharge of ill-neonates transported by ground or air ambulance to a tertiary center

Alvarado-Socarras, Jorge Luis; Idrovo, Alvaro Javier; Bermon, Anderson

doi:10.1016/j.jped.2015.07.010

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Original articles • J. Pediatr. (Rio J.) 92 (3) • May-Jun 2016 • https://doi.org/10.1016/j.jped.2015.07.010 copy

Hospital survival upon discharge of ill-neonates transported by ground or air ambulance to a tertiary center^☆ ☆ Please cite this article as: Alvarado-Socarras JL, Idrovo AJ, Bermon A. Hospital survival upon discharge of ill-neonates transported by ground or air ambulance to a tertiary center. J Pediatr (Rio J). 2016;92:276-82.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate the differences in hospital survival between modes of transport to a tertiary center in Colombia for critically ill neonates.

Methods:

Observational study of seriously ill neonates transported via air or ground, who required medical care at a center providing highly complex services. Data on sociodemographic, clinical, the Transport Risk Index of Physiologic Stability (TRIPS), and mode of transport were collected. Patients were described, followed by a bivariate analysis with condition (live or dead) at time of discharge as the dependent variable. A multiple Poisson regression with robust variance model was used to adjust associations.

Results:

A total of 176 neonates were transported by ambulance (10.22% by air) over six months. The transport distances were longer by air (median: 237.5 km) than by ground (median: 11.3 km). Mortality was higher among neonates transported by air (33.33%) than by ground (7.79%). No differences in survival were found between the two groups when adjusted by the multiple model. An interaction between mode of transport and distance was observed. Live hospital discharge was found to be associated with clinical severity upon admittance, birth weight, hemorrhaging during the third trimester, and serum potassium levels when admitted.

Conclusions:

Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation) to obtain good clinical outcomes according type of ambulance.

Keywords
Ambulance; Ground; Air; Transport; TRIPS

Variables		Distance			Mode of transport				p-Value
		Median	Min-max	p-Value	Ground transportation	%	Air transportation	%
Alive at discharge		62.00	0-1126	0.99	142	89.87	12	66.67	0.01

Sex
	Male	130.36	0-701	0.98	102	64.56	8	44.44	0.08
	Female	134.33	0-1126		56	35.44	10	55.56

Gestational age
	<28 weeks	98.43	0-513	0.84	17	10.76	1	5.56	0.97
	28-32 weeks	117.17	0-506		15	9.49	1	5.56
	32-35 weeks	122.75	0-660		38	24.05	5	27.78
	35-38 weeks	127.46	0-701		30	18.99	4	22.22
	>38 weeks	153.00	0-1126		58	36.71	7	38.89

Birth weight
	Less than 1000 g	101.00	0-513	0.64	17	10.76	1	5.56	0.44
	Between 1000 and 1500 g	134.35	0-506		10	6.33	3	16.67
	Between 1500 and 2500 g	111.74	0-456		43	27.22	4	22.22
	Over 2500 g	146.85	0-1126		88	55.70	10	55.56

Social security
	Contributive	57.5	0-513	<0.001	57	36.08	5	27.78	0.51
	Subsidized	184.3	0-1126		82	51.9	12	66.67
	Other	116.1	0-456		19	12.03	1	5.56

Human resources in the ambulance
	Specialist physician	119	0-214	0.87	5	3.2	4	22.22	0.01
	Other	133	0-1126		152	96.8	14	77.78
	Congenital disease	214.70	0-701	0.01	25	15.82	6	33.33	0.06
	Congenital cardiopulmonary disease	224.35	0-620	0.24	6	3.80	2	11.11	0.19

Respiratory support
	Ventilator	268	10-589	<0.001	5	3.16	14	77.8	<0.001
	Hood chamber or nasal cannula	91	0-660		130	82.3	2	11.1
	No required	247	0-1126		23	14.6	2	11.1
	Maternal disease	115.23	0-620	0.44	35	22.15	6	33.33	0.29
	Pregnancy disease	110.37	0-620	0.09	49	31.01	4	22.22	0.43
	Uterine disease	137.00	10.4-456	0.59	9	5.70	0	0.00	0.60
	Maternal risk factor	131.62	0-589	0.55	43	27.22	6	33.33	0.59
	Without prenatal care	170.16	0-589	0.14	12	7.59	4	22.22	0.06
	Adverse events during transfer^a a Lack of intravenous access (n = 17), displacement of endotracheal tube (n = 4), accidental airway extubation (n = 3), need of intubation (n = 2), and another as pneumothorax and arrest cardiac (n = 5).	78.60	0-660	0.66	28	17.72%	2	11.11	0.74
	TRIPS	-	-		13	(5-46)^b b Q25-Q75 quartiles.	31	(5-58)^b b Q25-Q75 quartiles.	<0.001
	Distance in km	-	-		11.3	(10-179)^b b Q25-Q75 quartiles.	237.5	(10-1126)^b b Q25-Q75 quartiles.	<0.001

Variable		PR	95% CI	p-Value
Sex		1.11	(0.79-1.55)	0.533

Weight
	Less than 1000 g	1
	Between 1000 and 1500 g	1.69	(0.70-4.08)	0.242
	Between 1500 and 2500 g	1.74	(0.85-3.59)	0.131
	Over 2500 g	1.90	(0.96-3.76)	0.066

Congenital disease		0.82	(0.53-1.28)	0.384
Cardiovascular congenital disease		0.71	(0.29-1.72)	0.441
Maternal diseases ^a a Includes mainly diabetes mellitus, infections, and TORCH (T, toxoplasmosis; O, other infections; R, rubella; C, cytomegalovirus; H, herpes infections).		0.97	(0.66-1.41)	0.868
Pregnancy diseases ^b b Gestational diabetes, pre-eclampsia, premature rupture of membranes, placental abruption, placenta previa, multiple pregnancy.		0.98	(0.69-1.39)	0.911
Uterine diseases ^c c Placenta previa, placental abruption, and third trimester bleeding.		1.14	(0.58-2.25)	0.694
Maternal risk factors ^d d Smoking or using drugs, history of abortion, no prenatal care, less than 17 years of age.		0.96	(0.68-1.38)	0.841
Without prenatal control		0.85	(0.47-1.52)	0.576

Mode of transport
	Air ambulance	1
	Ground ambulance	3.29	(1.29-8.41)	0.013

Cerebral bleeding		0.68	(0.37-1.25)	0.209
Heart disease		0.65	(0.31-1.39)	0.267
Distance in km		0.99	(0.99-1.0)	0.947
Respiratory rate		1.09	(1.03-1.14)	0.001
Oxygen saturation		1.05	(1.0-1.1)	0.028
Weight at admission		1.00	(1.00-1.00)	0.000
FiO ₂		0.98	(0.96-0.99)	0.003
pH (less than 7.2)		0.79	(0.55-1.13)	0.196
pCO ₂		0.97	(0.95-0.99)	0.011
Sodium		1.12	(1.02-1.23)	0.018
Potassium		0.63	(0.43-0.92)	0.017
Hemoglobin		1.34	(1.13-1.59)	0.001
Hematocrit		1.10	(1.04-1.17)	0.001
Urea nitrogen		0.95	(0.93-0.98)	0.001
TRIPS		0.91	(0.88-0.95)	0.001

Variables		aPR	p-Value	95% CI
Mode of transport
	Transported via ground	1
	Transported by air	0.65	0.128	0.38	1.13

TRIPS		0.99	0.005	0.98	0.99

Interaction
	Mode of transport × Distance (km)	1.0	0.14	0.99	1.00
	Distance (km)	0.99	0.846	0.99	1.01

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E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mails:jorgealso2@yahoo.com, jorgealvarado@fcv.org (J.L. Alvarado-Socarras).