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. 2018 Aug;142(2):e20173360.
doi: 10.1542/peds.2017-3360. Epub 2018 Jul 13.

Adverse Events in Hospitalized Pediatric Patients

David C Stockwell  1   2 , Christopher P Landrigan  3   4   5 , Sara L Toomey  3   4 , Samuel S Loren  3 , Jisun Jang  3 , Jessica A Quinn  3 , Sepideh Ashrafzadeh  3 , Michelle J Wang  3 , Melody Wu  3 , Paul J Sharek  6 , David C Classen  7 , Rajendu Srivastava  8   9   10 , Gareth Parry  4   11 , Mark A Schuster  12   4 ; GAPPS Study Group
Affiliations

Adverse Events in Hospitalized Pediatric Patients

David C Stockwell et al. Pediatrics. 2018 Aug.

Abstract

: media-1vid110.1542/5789657761001PEDS-VA_2017-3360Video Abstract BACKGROUND: Patient safety concerns over the past 2 decades have prompted widespread efforts to reduce adverse events (AEs). It is unclear whether these efforts have resulted in reductions in hospital-wide AE rates. We used a validated safety surveillance tool, the Global Assessment of Pediatric Patient Safety, to measure temporal trends (2007-2012) in AE rates among hospitalized children.

Methods: We conducted a retrospective surveillance study of randomly selected pediatric inpatient records from 16 teaching and nonteaching hospitals. We constructed Poisson regression models with hospital random intercepts, controlling for patient age, sex, insurance, and chronic conditions, to estimate changes in AE rates over time.

Results: Examining 3790 records, reviewers identified 414 AEs (19.1 AEs per 1000 patient days; 95% confidence interval [CI] 17.2-20.9) and 210 preventable AEs (9.5 AEs per 1000 patient days; 95% CI 8.2-10.8). On average, teaching hospitals had higher AE rates than nonteaching hospitals (26.2 [95% CI 23.7-29.0] vs 5.1 [95% CI 3.7-7.1] AEs per 1000 patient days, P < .001). Chronically ill children had higher AE rates than patients without chronic conditions (33.9 [95% CI 24.5-47.0] vs 14.0 [95% CI 11.8-16.5] AEs per 1000 patient days, P < .001). Multivariate analyses revealed no significant changes in AE rates over time. When stratified by hospital type, neither teaching nor nonteaching hospitals experienced significant temporal AE rate variations.

Conclusions: AE rates in pediatric inpatients are high and did not improve from 2007 to 2012. Pediatric AE rates were substantially higher in teaching hospitals as well as in patients with more chronic conditions.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Drs Stockwell and Classen disclose that they are employees for Pascal Metrics, a Patient Safety Organization; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Severity of all AEs and preventable AEs. NCCMERP categories are as follows: E, contributed to or resulted in temporary harm to the patient and required intervention; F, contributed to or resulted in temporary harm to the patient and required initial or prolonged hospitalization; G, contributed to or resulted in permanent patient harm; H, required intervention to sustain life; I, contributed to or resulted in the patient’s death.
FIGURE 2
FIGURE 2
Distribution of AEs by hospital and clinical characteristics. The values presented are unadjusted. High-severity AEs are defined as NCCMERP categories F to I. A, All AEs per 1000 patient days. B, All AEs per 100 admissions. C, Preventable AEs per 1000 patient days. D, Preventable AEs per 100 admissions. E, High-severity AEs per 1000 patient days. F, High-severity AEs per 100 admissions. ** P < .01; *** P < .001.
FIGURE 3
FIGURE 3
Rates of all AEs, preventable AEs, and high-severity AEs per 1000 patient days, according to quarter. The values presented are unadjusted. A, All AEs. B, By hospital type, all AEs. C, Preventable AEs. D, By hospital type, preventable AEs. E, High-severity AEs. High-severity AEs are defined as NCCMERP categories F to I. F, By hospital type, high-severity AEs. Qtr, quarter.
FIGURE 4
FIGURE 4
Rates of all AEs, preventable AEs, and high-severity AEs per 100 admissions, according to quarter. The values presented are unadjusted. A, All AEs. B, By hospital type, all AEs. C, Preventable AEs. D, By hospital type, preventable AEs. E, High-severity AEs. High-severity AEs are defined as NCCMERP categories F to I. F, By hospital type, high-severity AEs. Qtr, quarter.
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References

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