Frequency of medication error in pediatric anesthesia: A systematic review and meta-analytic estimate
Max M Feinstein1, Anthony E Pannunzio2, Pilar Castro3
1School of Medicine, Case Western Reserve University, Cleveland, Ohio.
Insights
Pediatric anesthesia medication errors occur at a rate of 1 in 1250 administrations. This systematic review highlights potential issues with current research methods for pediatric anesthesia errors.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Patient Safety
Background:
- Pediatric anesthesia patients face higher risks of life-threatening medical errors compared to adults.
- Medication errors in adult anesthesia occur at an estimated rate of 1 in 133 administrations.
- Specific rates for pediatric anesthesia medication errors were previously undetermined.
Purpose of the Study:
- To systematically review and meta-analyze the existing literature on medication errors in pediatric anesthesia.
- To determine a precise rate of medication error in pediatric anesthesia patients.
Main Methods:
- A systematic literature review was performed using multiple databases (Medline, Cochrane, PROSPERO, Clinicaltrials.gov).
- Meta-analytic estimation was employed to calculate the overall medication error rate.
- Subgroup sensitivity analyses were conducted to explore heterogeneity among studies.
Main Results:
- 13 studies met the inclusion criteria from an initial screening of 433 records.
- The meta-analytic estimate for pediatric anesthesia medication error rate was 0.08% (1 in 1250 anesthetics).
- Higher error rates were noted in children under one year of age in six individual studies.
Conclusions:
- The study identified a pediatric anesthesia medication error rate significantly lower than anticipated for adults.
- This finding raises concerns about the methodologies and reporting in pediatric anesthesia error research.
- Future research should utilize methods beyond self-reporting, such as retrospective chart reviews.
Background:
Clinical evidence shows that pediatric anesthesia patients are subject to a higher rate of life-threatening medical errors than their adult counterparts. Medication error in adult anesthesia is estimated to occur to 1 in 133 anesthetic administrations, but such a figure has not been determined for pediatric anesthesia patients. Individual studies of medication error in pediatric anesthesia have ranged from rates of 0.01% to 1.92% of anesthetic uses. The present study is a systematic review that employs a meta-analytic estimate to determine the rate of medication error in pediatric anesthesia.
Methods:
A systematic review of the literature on pediatric anesthesia medication error was conducted using Medline, Cochrane Database, PROSPERO, and Clinicaltrials.gov. A meta-analytic estimate was used to determine the medication error rate for all of the included studies. Subgroup sensitivity analysis was used to evaluate possible sources of heterogeneity in included studies.
Results:
Of the 433 initially screened records, 13 studies met inclusion criteria. Meta-analytic estimate of medication error rate across all studies was 0.08% (95% CI 0.05%-0.10%), or 1 out of 1250 anesthetics. Ten different countries were represented in the studies. Sample size of anesthetics reported on ranged from 296 to 2 316 635. Data collecting periods ranged from 3 months to 15 years. Six included studies individually reported higher rates of medication error in patients under 1 year of age.
Conclusion:
The present systematic review revealed a medication error rate of 1 per 1250 anesthetic administrations in pediatric anesthesia. This result is significantly lower than would be expected given reported rates of medication error in adult anesthesia, which raises questions regarding the validity of research methods and reporting of medication error in pediatric anesthesia. Future investigations of medication error should employ methodologies other than self-reporting of error, such as retrospective chart review.
Related Concept Videos
01:15Systematic Error: Methodological and Sampling Errors
Sampling errors originate from improper sampling methods or the wrong sample population. These errors can be minimized by refining the sampling strategy. Defective instruments or faulty calibrations are the sources of instrumental...
01:20Random and Systematic Errors
01:10Propagation of Uncertainty from Systematic Error
01:14Fundamental Attribution Error
01:10Review and Preview
Percentiles are a type of fractile that partition data into...
01:13Review and Preview