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Research Snapshot Theater: Future of Critical Care, Pediatric I

Geographic Thresholds of Time and Distance and Outcomes of Transferred Critically Ill Children

Tuesday, March 24, 2026
8:45 AM - 9:45 AM Central Time
Location: Connections Central - RST 03
  • CM

    Courtney Massey, DO (she/her/hers)

    Oklahoma

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • MG

    M. Connor Garbe, MPH

    Research Biostatistician
    University of Oklahoma Health Sciences Center, Department of Pediatrics

    Disclosure information not submitted.

  • XL

    Xiaolan Liao, Ph.D.

    Assistant Professor
    University of Oklahoma Health Sciences Center, Oklahoma

    Disclosure information not submitted.

  • JC

    Janis Campbell, Ph.D., M.Sc.

    Professor
    Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma

    Disclosure information not submitted.

  • AG

    Andrew Gormley, MD

    Associate Professor of Pediatrics
    Department of Pediatrics (Critical Care), University of Oklahoma

    Disclosure information not submitted.

  • Manzilat Akande, MD, MPH, MS (she/her/hers)

    University of Oklahoma Health Sciences Center, Oklahoma

    Disclosure information not submitted.

Introduction: With regionalization of pediatric acute care, more critically ill children are transferred to tertiary hospitals. However, the impact of geographic thresholds on outcomes among transported critically ill children is underexplored. We aimed to investigate the relative impact of time and distance thresholds on outcomes of transported critically ill children, hypothesizing that longer time and farther distance are associated with worse outcomes.


Methods: Retrospective, single-center cohort study of 1260 admissions (2014-2021) for children < 18 years of age who were transferred to a tertiary pediatric intensive care unit (PICU). Referring hospital locations were geocoded to determine distance (in kilometers(km)) using geospatial techniques to account for mode of transport. Transfer time (mins) was calculated as the interval between transfer initiation and PICU arrival. Regression models were used to assess the association between PICU mortality and time and distance separately, adjusted for demographic, clinical, and referring hospital factors. Pediatric Index of Mortality 2 (PIM2) was used to assess illness severity.


Results: Overall, PICU mortality was 3.4% (43/1260), and median PIM2 score was -4.74 (IQR -6.20, -3.47; predicted death rate of 0.01 (IQR 0.002, 0.03)). Those with distance < 50km (32% of cohort) and time ≤90 mins (9% of cohort) accounted for 44% and 19% of deaths, respectively. Adjusted analysis showed decreased odds of mortality for those with time ≤ 180 mins (OR 0.2; 95%CL 0.1-0.6) vs ≤ 90 mins, and for those with distance 100-150 km (OR, 0.4; 95%CI 0.1-0.9) and ≥150km (OR 0.2, 95%CI 0.07-0.5) vs distance < 50km. Factors associated with increased odds of mortality were air (vs ground) transport, presence of chronic complex conditions (vs none), and weekend (vs weekday). PIM2 scores were consistently low across time (p=0.07) and distance thresholds (p=0.6).


Conclusions: In this study, shorter transfer time and distance were independently associated with increased mortality, and illness severity was relatively low across all time and distance thresholds. Although this might indicate transfer of low-acuity patients to a tertiary PICU, this study does not include pre-transfer mortality at the referring hospitals. Further prospective research is needed to confirm these findings.