Diagnosis Discordance and Neonatal Transport: A Single-Center Retrospective Chart Review

Abstract

Introduction In Canada, more than 4,000 critically ill newborns per year require transfer. Transports are initially managed based on information conveyed by referral practitioners.

Objectives To identify the frequency of diagnostic discordance between the referring facility, transport team, and tertiary care center in our outborn neonatal population and to verify the association between discordance events (DEs), prolonged transport stabilization times, and potential risk factors to further inform and facilitate the development of future outreach education initiatives.

Study Design In this retrospective chart review, we identified and categorized DEs for patients transported by our service in a 1-year period. Associations between DE, transport stabilization times, and patient variables were studied using univariate and multivariable approaches.

Results From 233 eligible patients, 10.7% of patients had referral to discharge discordance events. No significant association was identified between stabilization time and DE. Birth weight and presence of a neurologic diagnosis were associated with DE.

Conclusion Diagnostic discordance was identified in 1 of every 10 neonates transported and found to be associated with patients with higher birth weight and the presence of neurologic diagnoses. Outreach initiatives will be developed and adapted accordingly, with a focus on this population.

Keywords

interfacility transport - newborn - outborn - diagnosis discordance

• References

• 1 Whyte HE, Jefferies AL. ; Canadian Paediatric Society, Fetus and Newborn Committee. The interfacility transport of critically ill newborns. Paediatr Child Health 2015; 20 (05) 265-275
• 2 Ajizian SJ, Nakagawa TA. Interfacility transport of the critically ill pediatric patient. Chest 2007; 132 (04) 1361-1367
• 3 Orr RA, Felmet KA, Han Y. , et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics 2009; 124 (01) 40-48
• 4 Shivananda S, Kirsh J, Whyte HE, Muthalally K, McNamara PJ. Accuracy of clinical diagnosis and decision to commence intravenous prostaglandin E1 in neonates presenting with hypoxemia in a transport setting. J Crit Care 2010; 25 (01) 174.e1-174.e9
• 5 Provincial Council for Maternal and Child Health Standardization. Standardized Maternal and Newborn Levels of Care Definitions. Available at: http://www.pcmch.on.ca/health-care-providers/maternity-care/pcmch-strategies-and-initiatives/loc/ . Accessed January 12, 2018
• 6 Aubertin C, Sampaio T, Mason-Ward M, Redpath S. Pre-Transport Stabilization Resource: Regional Needs Assessment. Presented at the 16th Annual Airborne Neonatal & Pediatric Transport Conference, Austin, TX, May 2–4, 2018
• 7 Lee K, Whyte HE, Shah P. , et al. Improving Quality of Care during Transport of Sick Neonates: A National Collaborative Partnership for Outcome Improvement and System enhancement; Canadian Institute of Health Research Partnerships for Health System Improvement Grant. June 1, 2013, to May 31, 2016
• 8 Lee SK, Zupancic JAF, Pendray M. , et al; Canadian Neonatal Network. Transport risk index of physiologic stability: a practical system for assessing infant transport care. J Pediatr 2001; 139 (02) 220-226
• 9 R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria; 2016 . Available at: https://www.r-project.org/
• 10 Philpot C, Day S, Marcdante K, Gorelick M. Pediatric interhospital transport: diagnostic discordance and hospital mortality. Pediatr Crit Care Med 2008; 9 (01) 15-19