Using the paediatric index of morality score to report severity of illness in babies and children retrieved by NSW Newborn and Paediatric Emergency Transport Service (NETS NSW)
Tina Kendrick / Sandra Farrugia
NSW Newborn and paediatric Emergency Transport Service
Tina Kendrick is the Clinical Nurse Consultant - Paediatrics at NETS NSW and a Clinical Lecturer and doctoral student at the University of Tasmania. Tina has been practicing, teaching and researching in paediatrics and critical care for the past three decades. She has co-authored book chapters and journal articles on critically ill children, critical care nurse practice standards, credentialing for specialist critical care nurses, and transition to specialty practice. Tina’s current projects are focussed on bronchiolitis, humidified high flow oxygen therapy in infants and children, clinical handover and use of the paediatric index of mortality (PIM) in the retrieval setting.
The NSW Newborn and Paediatric Emergency Transport Service (NETS) retrieve over 1500 babies and children annually. Severity of illness reports of children requiring retrieval to tertiary centres are scarce in the literature. In 2010 we determined feasibility of PIM score application in retrieval patients by applying Paediatric Index of Mortality Score (PIM2) retrospectively on 4686 children retrieved over 5 years.
From January 1, 2015 the updated Paediatric Index of Mortality Score (PIM3) was used to assess severity of illness in all eligible patients where NETS NSW attended.
Physiological data and other PIM3 variables were collected on all eligible babies and children. PIM3 Risk of Death (PIMROD) and number of expected deaths were calculated and banded into five categories: 0 1%, >1-5%, >5-15%, >15-30% and >30-100%. Most newborns and those babies and children who died before NETS team contact were excluded. Outcome data was obtained via data sharing with the Sydney Children’s Hospitals Network ICUs and routine NETS follow-up.
In 2015 there were 785 babies and children eligible for a PIM3 score. PIM predicted 23 deaths, with 20 actual deaths in our cohort. The crude mortality rate was 2.68% and standardised mortality rate was 0.86 (95% CI = 0.53-1.34), both comparable with the 2015 Australian and New Zealand Paediatric Intensive Care Registry crude mortality rate of 2.26% and standardised mortality rate of 0.95 (95% CI = 0.85 – 1.05).
Over 75% of babies and children who died had a very high PIMROD (>30%), with no deaths in children with a very low PIMROD (>1%). Three children died prior to retrieval in the referring hospital with NETS in attendance. Almost 40% of babies and children were retrieved to Emergency. Retrievals to Intensive Care increased from 25% in 2005 to 50% in 2009 and over 58% in 2015, while mortality remained essentially unchanged.