Use of Transport Illness Severity Scores To Predict Risk Of Clinical Deterioration In Transported Patients

Introduction: The Transport Pediatric Early Warning Scores (TPEWS) and Transport Risk Assessment in Pediatrics (TRAP) scores are transport medicine-specific illness severity scores that are adjunct assessment tools for determining patient disposition. We hypothesized that these scores would predict acuity and risk of clinical deterioration in transported patients admitted to general pediatric wards. We utilized activation of a rapid response team (RRT) in the first 24 hours of admission as a marker of deterioration. Methods: We reviewed all pediatric transports admitted via our pediatric critical care transport team to our tertiary care children's hospital wards or PICU from July 1, 2018-June 30, 2019. Patients transported to the emergency department (ED) were excluded. Transports via ALS were excluded as these are all triaged through the ED. A pediatric intensivist was medical control physician for all included transports. A retrospective chart review evaluated TRAP and TPEWS scores at three points: (1) arrival of transport team to patient at referring hospital, (2) admission to the children's hospital, and (3) RRT activation, if occurring within 24 hours of admission. Results: There were 329 team transports during this 12 month period. We excluded 99 patients who were transported to the ED. The study included a total of 230 patient transports, 107 (47%) patients were admitted to the PICU and 123 (53%) patients were admitted to the general pediatric wards. Thirteen patients admitted to the general wards had an RRT activation within 24 hours of admission (11%). Of the RRTs, half were transferred to the PICU. There was no correlation between time from admission to time of RRT and rate of transfer to the PICU. Of note, over this same time period, there were a total of 235 RRT activations on the general care wards (6% of total RRTs were on patients admitted via transport). Statistical analysis was done utilizing two sample t-tests. Patients admitted to the PICU had statistically significant higher TRAP and TPEWS scores (TRAP mean score 2.37 for patients admitted to wards vs. PICU 3.44, p <0.001; TPEWS mean score 1.33 for patients admitted to wards vs. PICU 2.79, p<0.001 (see Figure 1)). There was also a statistically significant difference in scores for ward admissions between those that had RRT activation and those that did not (TRAP mean score 3.81 for ward admission with RRT vs. without RRT 2.2, p<0.0001, TPEWS mean score 2.27 for ward admission with RRT vs. without RRT 1.21, p=0.003 (see Figure 2)). Conclusions: Our study demonstrates that TRAP and TPEWS scores can be used to predict acuity and risk of clinical deterioration in transported patients admitted to general pediatric wards. The use of these scores may assist in assessing which patients admitted to the wards may require closer observation.