Do specialist transport personnel improve hospital outcome in critically ill patients transferred to higher centers? A systematic review.

PURPOSE The aim of the study was to determine whether the use of specialist transport personnel improves patient outcome at the receiving hospital for critically ill patients transferred to higher centers. MATERIALS AND METHODS A search of 6 electronic databases, 15 relevant journals, and the reference lists of all retrieved articles was conducted for studies comparing outcome at the receiving hospital for critically ill adult or pediatric patients transported by dedicated transport crews or tertiary-based specialists with other forms of transport personnel including referring house staff. All potentially relevant articles were retrieved in full and reviewed independently by 2 reviewers to determine eligibility for inclusion. Data were tabulated and results were summarized. RESULTS Six cohort studies (n = 4534) were included. When patients of equal severity were assessed, only 1 study demonstrated an improvement in outcome at the receiving hospital (survival to 6 hours) when specialist personnel transported the patients. Methodological limitations and interstudy differences in participants and transport personnel precluded pooling of results. CONCLUSIONS Current data are insufficient. The study designs used create opportunity for significant bias, preventing any useful inferences to be drawn. Further study is warranted.