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Adverse events and preventable adverse events in children
Donna Woods1, Eric Thomas, Jane Holl
1Institute for Health Services Research and Policy Studies, Feinberg School of Medicine, Northwestern University, 339 E Chicago Ave, Chicago, IL 60611, USA. woods@northwestern.edu
Insights
Pediatric hospitalizations show a 1% adverse event rate, with 0.6% preventable. Most preventable adverse events in children involve birth or diagnostic issues, differing from adult rates.
Area of Science:
- Pediatric Healthcare Quality
- Patient Safety Research
- Medical Error Analysis
Background:
- Patient safety is a critical healthcare concern, yet data on adverse events in children remain limited.
- Understanding adverse events and preventable adverse events is crucial for improving pediatric care.
Purpose of the Study:
- To determine the incidence and types of adverse events in pediatric hospitalizations.
- To identify the proportion and nature of preventable adverse events among hospitalized children.
Main Methods:
- Retrospective analysis of pediatric hospitalizations in Colorado and Utah (Medical Practice Study).
- Involved a two-level medical record review (nurse and physician) of a representative sample.
- Defined adverse events as injuries from medical management and preventable events as avoidable based on current knowledge.
Main Results:
- Adverse events occurred in 1% of pediatric hospitalizations; 0.6% were preventable.
- Preventable adverse event rates varied by age: 0.53% (infants), 0.22% (children), and 0.95% (adolescents).
- Birth-related (32.2%) and diagnostic-related (30.4%) events were the most common preventable adverse events in children.
Conclusions:
- An estimated 70,000 hospitalized children experience adverse events annually in the U.S., with 60% potentially preventable.
- The epidemiology of adverse events in children differs significantly from that in adults.
- Future research should target adolescent care, birth-related medical care, and pediatric diagnostics to reduce adverse events.
Context:
Patient safety has been recognized as an important problem in health care. However, knowledge about adverse events and preventable adverse events in children is relatively limited.
Objective:
To describe the incidence and types of adverse events and preventable adverse events in children.
Design:
Analysis of pediatric hospitalizations in the Colorado and Utah Medical Practice Study, which involved a retrospective, 2-level (nurse and physician) medical record review of a population-based, representative sample of all pediatric hospital discharges.
Main Measures:
Adverse events were defined as an injury caused by medical management rather than disease processes that resulted in either prolonged hospitalization or disability at discharge. A preventable adverse event was defined as an avoidable adverse event based on currently available knowledge and accepted practices.
Patients:
3719 discharged hospital patients, 0-20 years old, and 7528 nonelderly (21-65 years old) discharged adult patients in Colorado and Utah.
Setting:
All hospitals in Colorado and Utah.
Results:
Adverse events occurred in 1% of pediatric hospitalizations in Colorado and Utah; 0.6% were preventable. Preventable adverse events rates were 0.53% in neonates and infants (0-0.99 years), 0.22% in children 1-12 years of age, and 0.95% in adolescents 13-20 years of age, compared with a rate of 1.50% in nonelderly adults. Of preventable adverse event types, birth related (32.2%) and diagnostic related (30.4%) events were the most common and were significantly more common than surgically related preventable adverse events (3.5%).
Conclusions:
These data suggest that approximately 70,000 children hospitalized in the United States experience an adverse event each year; 60% of these events may be preventable. The epidemiology of adverse events and preventable adverse events in children is different than in adults. To reduce the adverse events that occur in hospitalized children, research should focus on adolescent hospitalized patients, birth-related medical care, and diagnostics in pediatric medicine.
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