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Adverse Events Following Gastrointestinal Endoscopy in Children: Classifications, Characterizations, and Implications
Robert E Kramer1, Michael R Narkewicz
1Department of Pediatrics, Digestive Health Institute, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora.
Insights
Pediatric postendoscopic adverse events (AEs) occur more frequently than previously thought, with 2.6% of procedures resulting in an AE. Advanced endoscopic procedures showed higher AE rates, necessitating standardized surveillance systems for better patient outcomes.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Patient Safety
Background:
- Previous studies on pediatric endoscopic adverse events (AEs) primarily focused on immediate outcomes, potentially underestimating the true incidence.
- Limited data exists on the spectrum and severity of AEs following pediatric endoscopy.
Purpose of the Study:
- To comprehensively study postendoscopic adverse events (AEs) in children.
- To categorize pediatric AEs based on the level of medical intervention required.
Main Methods:
- A prospective observational study was conducted over 48 months at a single tertiary care children's hospital.
- Adverse events in pediatric patients within 72 hours of endoscopic procedures were tracked.
- Data on AE type, severity, and subsequent interventions were collected and analyzed.
Main Results:
- A total of 249 AEs were identified from 9577 procedures, yielding an overall AE rate of 2.6%.
- 1.7% of procedures resulted in AEs requiring medical evaluation or costs (≥ grade 2).
- Advanced or interventional endoscopic procedures had higher AE rates (5.6% overall, 4.4% for ≥ grade 2), with bleeding, infection, and perforation being the most common significant AEs.
Conclusions:
- Postendoscopic AEs requiring medical intervention occur more commonly in children than previously recognized.
- There is a need for standardized postendoscopy surveillance systems and clear definitions of AEs in pediatric populations.
Objective:
To conduct a comprehensive study of postendoscopic adverse events (AEs) in children, categorizing them by the level of intervention required.
Background:
Previous studies of endoscopic AE in children have focused on intraprocedural and short-term outcomes, such as bleeding, perforation, and infection, and may underestimate the incidence of AEs.
Design:
Prospective observational study tracking AEs in pediatric patients within 72 hours of an endoscopic procedure.
Setting:
Single-center study performed at an academic, tertiary care, free-standing children's hospital over a 48-month period, from July 2010 through June 2014.
Patients And Interventions:
Of 9577 pediatric endoscopic procedures, cases identified as having an AE during or following endoscopy were subject to additional chart review for abstraction of relevant data.
Main Outcome Measurements:
Type, severity, and subsequent interventions of AEs were the primary outcome measures. Events were categorized by severity grade, with grade 1, no intervention; grade 2, outpatient evaluation; grade 3, hospitalization or repeat endoscopy; grade 4, surgery or intensive care unit admission; and grade 5, death.
Results:
In total, 249 endoscopic AEs were recognized of 9577 procedures performed, yielding a rate of 2.6%. Of these, 160 were identified to result in medical evaluation and costs (≥grade 2) for a rate of 1.7%. Rates of endoscopic AE after advanced or interventional endoscopic procedures were higher, with 65 of 1167 events, resulting in a total AE rate of 5.6% and a rate of 4.4% for AE ≥ grade 2. There were 10 cases of significant bleeding (0.1%), 9 cases of infection (0.09%), and 12 cases of perforation (0.13%), primarily occurring with advanced/interventional procedures.
Limitations:
Single-center study, lack of standardized criteria for ED referral.
Conclusions:
AEs presenting within 72 hours of endoscopy and resulting in medical intervention, occur more commonly than previously recognized in children. Standardized postendoscopy surveillance systems and definitions of AEs are needed.
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