Introduction: Timely recognition and resuscitation of pediatric sepsis improve survival and reduce morbidity. Children with sepsis who present to general, non-pediatric emergency departments have increased mortality, possibly due to delayed resuscitation. Interfacility transport using a dedicated pediatric transport team is associated with improved outcomes but the frequency of interventions and their impact on outcomes remain unknown. We sought to describe the time to treatment of sepsis before transfer, the frequency of interventions provided by our transport team, and their effect on outcomes Methods: This was a single-center retrospective review of patients transported to our quaternary children’s hospital from 2021-2023. All patients < 18 years of age transferred from a referring ED, requiring at least 40ml/kg fluid bolus and/or initiation of vasoactives prior to PICU admission were included. Neonates, hospice patients, and traumas were excluded. We described the number of transport team interventions, time to treatment, and admission Pediatric Logistic Organ Dysfunction (PELOD) score. We assessed the association of the interventions with ICU LOS. Results: Fifty-seven children with suspected sepsis were transported to our PICU from 2021-2023. The median (IQR) ICU length of stay (LOS) was 184 (92-392) hrs, and 6 (10.5%) died. The median PELOD score on admission was 5 (2-8). The median times to first fluid bolus, initiation of antibiotics and initiation of vasoactives were 57 (34-130) minutes, 130 (66-220) minutes, and 141 (87-184) minutes respectively. Nearly half (47%, n= 27) of the patients received transport team interventions. Fourteen percent (n=8) received antibiotics, 28% (n=16) received fluid boluses, and 10% (n=6) required vasoactive initiation by the transport team. There was no significant association between transport team interventions or time to intervention and ICU LOS. Conclusions: Almost half of the children with sepsis required interventions by our transport team prior to PICU admission, suggesting that a dedicated pediatric transport team provides timely resuscitation in children with sepsis. Further study of the effect of these interventions will help determine their relative benefit, particularly in children who have not received optimal resuscitation prior to transport.
Chandran et al. (Sun,) studied this question.