559 - Critically Ill Children Transferred Away from a Level III PICU 2017-2025: Who and Why?

Publication Number: 1538.559

Noah W. Miranda, University of Massachusetts Medical School, Acushnet, MA, United States; Lauren Fortier, UMass Memorial Children's Medical Center, Worcester, MA, United States; Scot Bateman, UMass Chan Medical School, Worcester, MA, United States

Background: Caring for critically ill children in level II-III Pediatric ICUs (PICUs) requires careful consideration of transfer to a quaternary PICU when critical resources/subspecialists are not available locally. Reasons for transfer can help determine how best to advocate for patient needs locally, and to understand how to navigate the risk/benefit ratio of a vulnerable sick child being transferred. We sought to review all transfers away from our PICU over a prolonged period in a retrospective case series to categorize and understand the transfer burden for a Level III PICU with over 700 admissions/year.

Objective: This retrospective case series aims to describe patient transfers from our tertiary center in a mid-size urban city to quaternary centers.

Design/Methods: PICU admissions from October 2017 to March 2025 at a single level III PICU were reviewed for external transfers. Chart review of the PICU admission and transfer documentation was completed. Variables recorded included demographic data and hospitalization data including age, diagnosis, length of stay (LOS), and transfer reason. IRB approved.

Results: Of the 5782 PICU admissions during this time frame, 84 transfers (1.5%) occurred, approximately 1 transfer/month. The transfer cohort had an average LOS in the local PICU of 6.8 days prior to transfer (median 2 days). Transfers averaged 5.8 yrs old with 44% < 1yr old and 31% >12yrs old. Transfers were 53% male, 67% white, 19% black, and 27% hispanic. The majority (60%) utilized public health insurance and had a high social vulnerability index (49/84). 42% were intubated, 57% on non-invasive respiratory support,18% were on pressors. Reason for transfer centered around advanced cardiac (32%), respiratory (26%), neurologic (18%), other subspecialty care (19%), or family request (5%). Urgent or emergent escalation of care to quaternary ICU’s for cardiac ICU/surgery, neuroICU, pulmonary reasons was 44%, including 26% for ECMO referral (approximately 1 every 4 months).

Conclusion(s): The vast majority (98.5%) of patients in a level III PICU can be cared for locally, but some will likely require transfer to a quaternary center: 1 in 4 of those will be emergent such as an ECMO referral. The volume is low, but can be taxing for patients, staff, and families. Expanding services locally could impact over ½ of the transfers, though overall numbers are low and likely would not support funding of certain subspecialties or local ECMO. Safe transfer system and strong/timely communication with a quaternary center are important. Transfers were disproportionately disadvantaged and thus more impacted by leaving the local PICU.

Curriculum Vitae 31OCT2025.pdf