Comparison of Specialist and Nonspecialist Transport Teams for Emergency Neurosurgery

ObjectivesCurrent guidance in the United Kingdom recommends that children requiring emergency neurosurgical intervention should be transported by referring hospital (RH) teams. We aimed to compare transports performed by RH teams and by specialized pediatric critical care transport (PCCTs) teams in terms of timings and patient outcomes.MethodsWe conducted a retrospective analysis over a 5-year period of children admitted from an external hospital to the pediatric intensive care unit at a pediatric neurosurgical center and receiving emergency neurosurgery within 24 hours of admission. Data were collected on RH characteristics, patient demographics, clinical status, transfer method (RH or PCCT team), timings (arrival at neurosurgical center, neurosurgical procedure), and clinical outcomes (length of stay and mortality). Univariate analysis was used to compare patient characteristics, times, and outcomes between RH and PCCT team transfers. Survival analysis was performed to analyze arrival time by transfer modality.ResultsDuring the study period, 75 children with acute neurosurgical emergencies were transferred. Median age was 6.7 years (interquartile range, 1.8-10.7), and 63% had nontraumatic diagnoses. The commonest mode of transfer was by RH teams after initial referral to a PCCT team (53.3%). The median distance was greatest for transfers by RH teams (14 km). Overall median arrival time was 5 hours (interquartile range, 3.6-7.4) with no significant difference between groups (P = 0.3). Median length of pediatric intensive care unit stay and mortality did not differ between groups.ConclusionsSpecialist critical care transport teams are involved in one third of transfers of children with acute neurosurgical emergencies. While the overriding priority is timely transfer, a tailored approach to the use of PCCTs may be appropriate particularly for children presenting to hospitals nearer to neurosurgical centers.