Interhospital transport of children with bronchiolitis by a statewide emergency transport service

Abstract

OBJECTIVE: To investigate the rate of interhospital emergency transport for bronchiolitis and intensive care admission following the introduction of high flow nasal cannula and standardised paediatric observation and response charts. DESIGN: Retrospective cohort study. SETTING: A statewide paediatric intensive care transport service and its two referral paediatric intensive care units (PICUs) in Victoria, Australia. PARTICIPANTS: Children less than 2 years old emergently transported with bronchiolitis during two time periods: 2008–2012 and 2015–2019. MAIN OUTCOME MEASURES: Incidence rates of bronchiolitis transport episodes, PICU admissions and respiratory support. RESULTS: 802 children with bronchiolitis were transported during the study period, 233 in the first period (2008–2012) and 569 in the second period (2015–2019). The rate of interhospital transport for bronchiolitis increased from 32.9 to 71.8 per 100 000 children aged 0–2 years. The population-adjusted rate of PICU admission increased from 16.2 to 36.6 per 100 000 children aged 0–2 years. Metropolitan hospitals were the predominant referral source and this increased from 60.1% of transports to 78.6% (P < 0.001). In children admitted to a PICU, the administration of high flow nasal cannula during transport increased significantly from 1.7% to 75.9% (P < 0.001) and a concomitant reduction in continuous positive airway pressure and mechanical ventilation occurred (40–12.4% and 27–6.9% respectively; P < 0.001). The proportion of mechanical ventilation as well as PICU and hospital length of stay decreased over time. CONCLUSIONS: The population-adjusted rate of interhospital transport and admission to the PICU for bronchiolitis increased over time. This occurred despite a lower rate of non-invasive and invasive mechanical ventilation during transport and in the PICU.