Cost-benefit of trained transport teams: estimates for head-injured children.
BACKGROUND
Care during transport influences the outcome of head-injured children. Secondary adverse events, e.g., hypotension and hypoxia, worsen morbidity and mortality. Trained transport teams lower the incidence of such secondary "insults."


OBJECTIVE
To estimate the cost-benefit of improved care from trained escorts.


METHODS
The setting was a provincial air ambulance service during transition to trained pediatric escort paramedics. A retrospective review of transport and hospital records for a 12-month period was conducted. All children with head injuries (n = 43) transported to tertiary care [11 by untrained escorts (UE), 32 by trained escorts (TE)] were enrolled. Severity of injury was classified by Glasgow Coma Score (GCS); incidence of adverse events was counted and cost of change of severity resulting from preventable insults was estimated using published care costs.


RESULTS
There were 13 preventable insults in six patients (55%) in the UE group and five preventable insults in four patients (12%) in the TE group (p<0.05). Among those in the UE group, two changed in severity from moderate to severe, one moderate worsened (decrease in GCS of 2 or more), and two severe worsened. In the TE group, there were no changes >1. Cost-benefit estimates based on change in severity were $136,000 (median) to $238,000 (mean).


CONCLUSIONS
Significant cost-benefit likely accrues from training escorts who transport children with significant head injuries to tertiary care.
Macnab
A J
AJ
Department of Pediatrics, University of British Columbia, Vancouver, Canada. amacnab@cw.bc.ca
Wensley
D F
DF
Sun
C
C
D002170:Canada; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006259:Craniocerebral Trauma / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D004634:Emergency Medical Technicians / Q000191:economics* / Q000592:standards; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007318:Inservice Training; D010348:Patient Care Team / Q000191:economics*; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000191:economics*