title: Enhanced monitoring improves pediatric transport outcomes: a randomized controlled trial.
abstract: BACKGROUND
  The "golden-hour" concept has led to emphasis on speed of patient delivery during pediatric interfacility transport. Timely intervention, in addition to enhanced monitoring during transport, is the key to improved outcomes in critically ill patients. Taking the ICU to the patient may be more beneficial than rapid delivery to a tertiary care center.
  
  
  METHODS
  The Improved Monitoring During Pediatric Interfacility Transport trial was the first randomized controlled trial in the out-of-hospital pediatric transport environment. It was designed to determine the impact of improved blood pressure monitoring during pediatric interfacility transport and the effect on clinical outcomes in patients with systemic inflammatory response syndrome and moderate-to-severe head trauma. Patients in the control group had their blood pressure monitored intermittently with an oscillometric device; those in the intervention group had their blood pressure monitored every 12 to 15 cardiac contractions with a near-continuous, noninvasive device.
  
  
  RESULTS
  Between May 2006 and June 2007, 1995, consecutive transport patients were screened, and 94 were enrolled (48 control, 46 intervention). Patients in the intervention group received more intravenous fluid (19.8 ± 22.2 vs 9.9 ± 9.9 mL/kg; P = .01), had a shorter hospital stay (6.8 ± 7.8 vs 10.9 ± 13.4 days; P = .04), and had less organ dysfunction (18 of 206 vs 32 of 202 PICU days; P = .03).
  
  
  CONCLUSIONS
  Improved monitoring during pediatric transport has the potential to improve outcomes of critically ill children. Clinical trials, including randomized controlled trials, can be accomplished during pediatric transport. Future studies should evaluate optimal equipment, protocols, procedures, and interventions during pediatric transport, aimed at improving the clinical and functional outcomes of critically ill patients.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. stroudmichaelh@uams.edu
authors.forename: Michael H
authors.initials: MH
authors.lastname: Stroud
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.forename: Michele
authors.initials: M
authors.lastname: Moss
authors.forename: Richard
authors.initials: R
authors.lastname: Fiser
authors.forename: Stephen
authors.initials: S
authors.lastname: Schexnayder
authors.forename: Kanwaljeet
authors.initials: K
authors.lastname: Anand
mesh_terms: D001795:Blood Pressure Determination; D015924:Blood Pressure Monitors; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000592:standards*; D010360:Patient Transfer / Q000592:standards*; D011446:Prospective Studies; D016037:Single-Blind Method