title: Transport of critically ill children in a resource-limited setting.
abstract: OBJECTIVE
  To audit paediatric intensive care unit (PICU) transfer activity and transfer-related adverse events in a resource-limited setting.
  
  
  METHODS
  Twenty-two bed regional PICU of a university children's hospital in Cape Town, South Africa. Prospective 1-year audit of all children transferred directly from other hospitals. Data were collected for patient demographics, diagnostic category, referring hospital, transferring personnel, mode of transport, and technical, clinical, and critical adverse events. Data are median (interquartile range) or percentages. The transfers of 202 children, median age 2.8 months (1.1-14), median weight 3.5 kg (2.5-8.1) were analysed.
  
  
  RESULTS
  Most transfers were performed by paramedic personnel (82%) and via road ambulance (76%). One or more technical adverse events occurred in 36%, clinical adverse events in 27%, and critical adverse events in 9% of children. Retrievals by intensive care staff (10%), all from rural hospitals, had a lower incidence of technical adverse events (0%). Children transferred from non-academic hospitals within the metropolitan area had the highest incidence of technical (44%), clinical (39%), and critical (17%) adverse events. Crude mortality was 17% ( n=34). Technical adverse events were not associated with mortality. Non-survivors were more likely to develop shock (32%) or hypoxia (26%) during transfer than survivors (10% and 11%, respectively).
  
  
  CONCLUSIONS
  There is a high incidence of transfer-related adverse events, most commonly in transfers from non-academic metropolitan hospitals. Further studies are needed to assess the impact of regional paediatric life support training or a specialised retrieval team on clinical adverse events and mortality.
authors.affiliation: Institute of Child Health, Red Cross War Memorial Children's Hospital, Klipfontein Road, 7700 Cape Town, South Africa. hatheril@ich.uct.ac.za
authors.forename: Mark
authors.initials: M
authors.lastname: Hatherill
authors.forename: Zainab
authors.initials: Z
authors.lastname: Waggie
authors.forename: Louis
authors.initials: L
authors.lastname: Reynolds
authors.forename: Andrew
authors.initials: A
authors.lastname: Argent
mesh_terms: D003363:Cost Control; D003422:Critical Care / Q000191:economics* / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008507:Medically Underserved Area; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000191:economics* / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000145:classification / Q000706:statistics & numerical data; D012769:Shock / Q000453:epidemiology / Q000628:therapy; D013019:South Africa / Q000453:epidemiology