The occurrence of adverse events in low-risk non-survivors in pediatric intensive care patients: an exploratory study

Carin W Verlaat,Joris Lemson,Cynthia Van Der Starre,Dick Tibboel,Jan A Hazelzet,Marieke Zegers,Johannes Van Der Hoeven

doi:10.1007/s00431-018-3194-y

Abstract

We studied the occurrence of adverse events (AEs) in low-risk non-survivors (LNs), compared to low-risk survivors (LSs), high-risk non-survivors (HNs), and high-risk survivors (HSs) in two pediatric intensive care units (PICUs). The study was performed as a retrospective patient record review study, using a PICU-trigger tool. A random sample of 48 PICU patients (0–18 years) was chosen, stratified into four subgroups of 12 patients: LNs, LSs, HNs, and HSs. Primary outcome was the occurrence of AEs. The severity, preventability, and nature of the indentified AEs were determined. In total, 45 AEs were found in 20 patients. The occurrence of AEs in the LN group was significantly higher compared to that in the LS group and HN group (AE occurrence: LN 10/12 patients, LS 1/12 patients; HN 2/12 patients; HS 7/12 patients; LN-LS difference, p < 0.001; LN-HN difference, p < 0.01). The AE rate in the LN group was significantly higher compared to that in the LS and HN groups (median [IQR]: LN 0.12 [0.07–0.29], LS 0 [0–0], HN 0 [0–0], and HS 0.03 [0.0–0.17] AE/PICU day; LN-LS difference, p < 0.001; LN-HN difference, p < 0.01). The distribution of the AEs among the four groups was as follows: 25 AEs (LN), 2 AEs (LS), 8 AEs (HN), and 10 AEs (HS). Fifteen of forty-five AEs were preventable. In 2/12 LN patients, death occurred after a preventable AE.Conclusion: The occurrence of AEs in LNs was higher compared to that in LSs and HNs. Some AEs were severe and preventable and contributed to mortality.What is Known:• 59–76% of all PICU patients encounter at least one adverse event during their PICU stay.• It is unknown if adverse events play a role in death of low-risk PICU patients.What is New:• In low-risk PICU non-survivors, occurrence of adverse events is higher compared to low-risk PICU survivors and to high-risk PICU non-survivors.• Severe and preventable adverse events occur in low-risk PICU non-survivors, some contributing to mortality.

Highlights

The mortality rate in the pediatric intensive care unit (PICU) in economically developed countries has decreased in the last decades to approximately 3% [26]
59–76% of all PICU patients encounter at least one adverse event during their PICU stay. It is unknown if adverse events play a role in death of low-risk PICU patients
Severe and preventable adverse events occur in low-risk PICU non-survivors, some contributing to mortality

Summary

Introduction

The mortality rate in the pediatric intensive care unit (PICU) in economically developed countries has decreased in the last decades to approximately 3% [26]. A substantial part of the PICU population (55% in a recent study) has a mortality risk of < 1% [35]. These are low-risk patients, some of these patients die on the PICU. It is interesting to analyze whether adverse events (AEs) or even medical errors play a role in the death of lowrisk PICU patients [3, 16]. In most international AE studies, (young) children were excluded or the number of included PICU admissions was not specified or very low, so data about PICU patients are scarce [2,3,4, 18, 38]

Methods

Results

Discussion

Conclusion