546 - Optimizing The Golden Hour: A dedicated pediatric interfacility transport team improves recognition and resuscitation of children with sepsis

Publication Number: 1525.546

Shreya Chandran, Children's Hospital of Michigan, Detroit, MI, United States; Robert Schultz, Children's Hospital of Michigan, Grosse Pointe Woods, MI, United States; Andrew Prout, Central Michigan University College of Medicine, Detroit, MI, United States; Jamie Bell, Central Michigan University College of Medicine, Berkley, MI, United States

Background: Early recognition and prompt treatment of pediatric sepsis improves survival and reduces disability. Children with sepsis who present to non-pediatric emergency departments have increased mortality. Interfacility transport using a pediatric transport team is associated with improved outcomes, but the frequency of interventions and their effect on outcomes is unknown.

Objective: We aimed to describe the time to treatment of sepsis prior to transfer, the frequency and intensity of interventions provided by our pediatric transport team, and its effect on outcomes.

Design/Methods: This was a single-center retrospective study of patients transported to our quaternary children’s hospital from January 2021- December 2024. We included patients transferred from a referring emergency department (ED) to the pediatric intensive care unit (PICU) who were < 18 years old and required at least 40ml/kg fluid bolus and/or vasoactive infusions prior to admission. We excluded neonates, hospice patients, and patients with traumatic injury. We described time to treatment and length of stay at the referring ED (ED LOS), transport team interventions, organ failure severity (measured by 7-day Pediatric Logistic Organ Dysfunction (PELOD) score), and the association of ED LOS and interventions with organ failure severity and ICU length of stay (LOS).

Results: During the study period, 113 children with sepsis were transported to our PICU. Median ED LOS prior to transport team arrival was 160 (83-239) mins. The median age was 5 (0.7-13) months, and 11 patients (9.7%) died. The median 7-day PELOD score was 12 (4-32). The median times to the first fluid bolus and initiation of antibiotics were 58 (34-110) minutes and 115 (65-226) minutes respectively. Forty-seven (41%) required transport team interventions including antibiotics (n=18, 16%), fluid bolus (n=26, 23%), and initiation of vasoactive support (n=11,10%). There was a significant association between shorter ED LOS and higher number of transport interventions (p=0.05),and between shorter ED LOS and organ failure severity (p=0.01). In multivariate regression, increased number of transport interventions was independently associated with increased organ failure severity (p=0.03). There was no significant association between ED LOS or number of transport interventions and ICU LOS.

Conclusion(s): Forty-one percent of children with sepsis required interventions by the transport team prior to PICU admission. Shorter ED LOS and higher number of transport interventions were associated with increased severity of organ failure.