O3300: The Race Against Sepsis: Are Helicopters Always Necessary When Transporting Sick Children? An Outcome Analysis of Transporting Children with Sepsis

Background: Several studies focus on the utilization of ground versus air transportation for pediatric traumatic injuries, but there are limited studies on the best mode of transportation for children with sepsis to tertiary care facilities. The aim of this study is to determine if there is a significant difference in transport time, length of stay, and mortality in ground versus rotor wing transport of pediatric patients with sepsis.

Methods: A retrospective chart analysis of electronic medical records was completed at a 255 bed tertiary care children’s hospital that functions as the region’s primary level 1 pediatric trauma center with ~81,000 visits annually to the pediatric emergency department. The study included patients from January 1, 2010- January 1, 2020 between the ages of 0-18 years who were transported by Pedi-flite, a neonatal and pediatric critical care transport team that utilizes ground and rotor wing transport. Patients included were those assigned International Classification of Diseases (ICD)-10 codes specific for a diagnosis of sepsis. Data collection included age, diagnosis, average distance traveled, receiving unit (ED, PICU), length of stay, discharge location, and time of transport.

Results: In our study of 149 patients diagnosed with sepsis, 113 patients were transported via ground and 36 by rotor wing. There was no statistical difference in time to dispatch and time to patient (156 minutes for rotor vs 199 minutes for ground, p = 0.11), and no statistical difference in length of stay between ground versus rotor wing (average length of stay for ground, 9.22 days vs 10.78 days for rotor, p = 0.6). Additionally, there was no statistical difference in survival when comparing ground and rotor wing (90% ground, 97% rotor, p= 0.4).

Conclusion: When comparing ground and rotor wing transport of patients with sepsis, our study indicates that there is no significant difference between transportation time to tertiary care facility, length of stay, or mortality. Although statistically insignificant, rotor wing resulted in faster arrival to patients compared to ground. At our institution, the rotor wing is a shared asset resulting in a time delay due to equipment loading and unloading prior to transport. Ground transport has an average cost of ~$2500 compared to rotor wing which can exceed $40,000.
Recognition and treatment of pediatric sepsis is a priority in decreasing morbidity and mortality in pediatric patients. Transporting a pediatric patient with sepsis is optimized when performed by a specialized neonatal and pediatric critical care team. Critical care that is initiated in the emergency department is continued when the critical care team arrives and throughout transport. While rotor wing gets the team to bedside sooner, this mode of transport does not improve the overall outcome for the patient.