141 QUALITY ASSURANCE SCORES FOR PAEDIATRIC TRANSPORT

Abstract

Background: Various scores (eg PRISM/CRIB) allow for quality assurance (QA) of care. Interhospital transport needs similar audit.

Method: 108 children coming to our ICU were assessed prospectively at 3 stages of care (initial contact, admission, next day) using 5 overlapping scores measuring clinical/physiological condition: PCS (Pediatric Coma Score), RAPS (Rapid Acute Physiology Score), PTS (Pediatric Trauma Score), RTS (Revised Trauma Score) and modified APACHE score.

Results: The 4 retained scales (APACHE was discarded - too complex) demonstrated substantial agreement in 3 age groups (<12 mos, 1-5 yrs, 5-12 yrs) and at all three stages of care. The sample was divided by time of transport: T₁ < 2 hrs (N=43), T₂ >2 hrs (N=28), and NT - no transport (ER admission) (N=37). T and NT groups differed significantly at initial contact and the following morning the NT cases had elevated PTS and PCS scores. A repeated measures MANOVA of the 4 scales at initial contact and admission by T/NT group, age group and neurological versus respiratory condition indicated a significant interaction between NT group and occasion (F=2.14, df=8, 182 p=0.034) due to elevated PCS and PTS scores in the NT group at initial contact. When all three occasions were considered (N=77), a significant effect was found for occasion (F=6.22, df=8, 58 p<0.001). This was entirely due to the 4 scale contrasts between initial contact and next day scores. No significant interactions with occasion were found.

Conclusion: The 4 scores provide a QA measure for transport, reliably monitoring stability or change in condition.

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