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The occurrence of adverse events in low-risk non-survivors in pediatric intensive care patients: an exploratory study
Carin W Verlaat1, Cynthia van der Starre2, Jan A Hazelzet3
1Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal Post 709, 6500 HB, Nijmegen, The Netherlands. carin.verlaat@radboudumc.nl.
Insights
Adverse events (AEs) occurred more frequently in low-risk pediatric intensive care unit (PICU) non-survivors than in other patient groups. Some severe, preventable AEs in this group contributed to patient mortality.
Area of Science:
- Pediatric critical care medicine
- Patient safety research
- Healthcare quality improvement
Background:
- Adverse events (AEs) are common in pediatric intensive care units (PICUs), affecting 59-76% of patients.
- The role of AEs in the mortality of low-risk PICU patients remains unclear.
Purpose of the Study:
- To investigate the occurrence and characteristics of AEs in low-risk non-survivors (LNs) within PICUs.
- To compare AE occurrence between LNs, low-risk survivors (LSs), high-risk non-survivors (HNs), and high-risk survivors (HSs).
Main Methods:
- Retrospective review of patient records from two PICUs.
- Utilized a PICU-trigger tool for AE identification.
- Sampled 48 pediatric patients (0-18 years), stratified into four equal groups: LNs, LSs, HNs, and HSs.
Main Results:
- A total of 45 AEs were identified in 20 patients.
- AE occurrence was significantly higher in LNs (10/12 patients) compared to LSs (1/12) and HNs (2/12).
- The AE rate was also significantly higher in LNs (0.12 AE/PICU day) versus LSs (0) and HNs (0).
- Fifteen of 45 AEs were preventable, and preventable AEs contributed to mortality in 2/12 LNs.
Conclusions:
- Low-risk PICU non-survivors experience a higher incidence of AEs compared to low-risk survivors and high-risk non-survivors.
- Severe and preventable AEs are present in the low-risk non-survivor group.
- These preventable AEs can impact mortality in this vulnerable patient population.
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.
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