Incidence and Risk Factors of Intrahospital Transport-Related Adverse Events in Critically Ill Neurosurgical Patients: A Single Institutional Experience from China.

Abstract

Intrahospital transport (IHT) of neurocritical care patients is a high-risk procedure that can exacerbate secondary brain injury. However, evidence specific to this population remains sparse, with most studies focusing on general intensive care cohorts. To investigate the incidence of adverse events (AEs) during IHT among critically ill neurosurgical patients and identify the associated risk factors. This prospective observational study was conducted between January 2025 and October 2025 in the neurosurgery department in China. In total, 214 patients were enrolled, each contributing one IHT episode to the analysis. All AEs occurring during transport were documented. Statistical analyses were performed using R version 4.3.1, including descriptive statistics and univariable analyses. Multivariable associations were estimated using Firth's penalized logistic regression to account for sparse-data bias. Overall, 56/214 transports (26%) were complicated by at least one AE. A total of 62 AEs were recorded, indicating that multiple complications could occur during a single transport. The incidence of oxygen saturation changes was 6.5%, that of heart rate fluctuations was 15%, and that of blood pressure-related complications was 7.5%. Multivariable analysis indicated that a transport duration of ≥30 min and vasoactive support were associated with higher odds of AEs. Conversely, intensive care unit-to-ward transfer and pre-transport stabilization were associated with lower odds of complications. AEs during IHT are frequent among critically ill neurosurgical patients. These findings address a significant gap in neurocritical care literature and provide actionable evidence to guide the development of tailored transport protocols for this vulnerable population.