Adverse events and severity of harm during intrahospital transport from the emergency department in critically ill pediatric patients: a prospective observational study

Intrahospital transport (IHT) of critically ill children (CIC) is frequently required for diagnostic and therapeutic interventions but is associated with a risk of adverse events (AEs). This study aimed to evaluate the incidence, characteristics, and severity of AEs during IHT from the emergency department (ED), and to identify factors associated with their occurrence. This prospective observational study was conducted in a tertiary pediatric ED between March 2022 and March 2024. All CIC undergoing IHT following life-saving interventions or requiring pediatric intensive care admission were included. Data on patient demographics, transport indications, monitoring, personnel, AEs, and harm severity (no harm/mild/moderate/severe/death) (classified using the WHO framework) were collected. Univariate and multivariate logistic regression analyses were performed to identify factors associated with AEs. A total of 1,017 transports involving 761 CIC were analyzed. The median age was 7.2 years; 57.4% were male. AEs occurred in 24.2% ( n = 246) of transports, most commonly due to hemodynamic alterations [139/246, (56.5%)], equipment-related issues [55/246, (22.4%)], and ventilation or oxygenation problems [49/246, (19.9%)]. Most AEs resulted in no harm (48.4%) or mild harm (43.1%), while severe harm was rare (1.2%), and no deaths were observed. Transport duration ≥ 20 min was significantly associated with AEs in univariate analysis (OR: 3.63, 95% CI: 2.68–4.93; p < 0.001). In multivariate analysis, transport duration ≥ 20 min (aOR: 2.30, 95% CI: 1.43–3.69; p < 0.001), age ≤ 1 year (aOR: 1.28, 95% CI: 1.03–1.60; p = 0.028), and out-of-working hours (OWH) ED presentation (aOR: 1.44, 95% CI: 1.10–1.88; p = 0.008) remained associated with increased AE risk. AEs during pediatric IHT are relatively common but are generally mild and non-fatal. Longer transport duration, younger age, and OWH ED presentation were associated with AEs, with longer transport duration likely reflecting cumulative exposure rather than an independent cause. Because monitoring practices and transport protocols were not experimentally evaluated, these observational findings identify transports that may warrant heightened vigilance rather than demonstrating the effectiveness of any specific preventive strategy. Not applicable.