Mortality and functional morbidity after use of PALS/APLS by community physicians.
OBJECTIVE
To test the hypothesis that pediatric shock is a common cause of death and functional morbidity and that pediatric advanced life support (PALS)/advanced pediatric life support (APLS) resuscitation in the community hospital setting improves child health outcomes.


METHODS
This study included all children consecutively transported to 5 regional, tertiary care children's hospitals over 4 years, and is a prospective cohort study comparing outcomes in children who did or did not receive PALS/APLS resuscitation in the community hospital.


RESULTS
Shock occurred in 37% of the patients transferred to the tertiary centers. Regardless of trauma status, children with shock had an increased mortality rate compared with those without shock (all patients: 11.4% vs 2.6%), trauma patients (28.3% vs 1.2%), and nontrauma patients (10.5% vs 2.8%). Early shock reversal was associated with reduced mortality (5.06% vs 16.37%) and functional morbidity (1.56% vs 4.11%) rates. Early use of PALS/APLS-recommended interventions was associated with reduced mortality (8.69% vs 15.01%) and functional morbidity (1.24% vs 4.23%) rates. After controlling for center, severity of illness, and trauma status, early reversal of shock and use of PALS/APLS-recommended interventions remained associated with reduced morbidity and mortality rates.


CONCLUSIONS
Shock is common in children who are transferred for tertiary care. Pediatric shock recognition and resuscitation in the community hospital improves survival and functional outcome regardless of diagnostic category. The development of shock/trauma systems for children with and without trauma seems prudent.
Carcillo
Joseph A
JA
Department of Pediatrics and Critical Care Medicine, University of Pittsburgh School of Medicine, Children's Hospitalof Pittsburgh, Pittsburgh, Pennsylvania, USA.
Kuch
Bradley A
BA
Han
Yong Y
YY
Day
Susan
S
Greenwald
Bruce M
BM
McCloskey
Karen A
KA
Pearson-Shaver
Anthony L
AL
Orr
Richard A
RA
D000293:Adolescent; D022561:Advanced Cardiac Life Support / Q000295:instrumentation*; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002200:Capillary Resistance / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D005260:Female; D006339:Heart Rate / Q000502:physiology; D017052:Hospital Mortality; D006764:Hospitals, Community; D006785:Hospitals, University; D006801:Humans; D007022:Hypotension / Q000401:mortality / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000401:mortality* / Q000628:therapy*; D010348:Patient Care Team; D011379:Prognosis; D012017:Referral and Consultation; D012769:Shock / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D013996:Time and Motion Studies; D014187:Transportation of Patients; D015599:Trauma Severity Indices; D014481:United States