NETS NSW Paediatric Trauma Inter-hospital Retrieval: A 10-year review of patient outcomes

Abstract

In New South Wales (NSW) there are multiple trauma transport providers. With only 3 paediatric trauma centres (PTC), nearly half of paediatric major trauma cases require inter-hospital transfer to reach definitive care. International literature reports reduced hospital length of stay (LOS), reduced mortality and reduced adverse events during transport for paediatric trauma patients retrieved by paediatric specialist teams compared to adult teams and paramedics. This study examined the quality of care delivered to paediatric trauma patients requiring inter-hospital transfer in NSW. This is a retrospective observational study of trauma patients aged 0-15 years, referred to the Newborn and paediatric Emergency Transport Service (NETS NSW) and were medically retrieved or transported to a PTC between 1 January 2010 and 31 December 2019. The primary outcome was acute morbidity, measured by admission to paediatric intensive care unit (PICU), and lengths of stay in PICU and hospital. Nine-hundred and thirty-two patients were included in the final analysis. We found no difference in PICU admission rate; PICU LOS; or hospital LOS between the paediatric retrieval team (NETS NSW) and the adult medical retrieval service (AMRS). There was a higher PICU admission rate for the regional retrieval service in this study, and this was associated with a shorter PICU and hospital LOS. NETS NSW teams on average spent the same amount of time stabilising patients at the referring hospital as AMRS teams. However, this study identified potentially modifiable delays related to teams reaching the patient’s and in NETS NSW teams’ departure once the patient was stabilised. Within the current trauma system, the inter-hospital transport process and providers are delivering an equitable level of service as measured in mortality, morbidity and time-based outcomes. However, opportunities exist to improve upon the medical retrieval response times