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Potentially Preventable Mortality in the Pediatric Intensive Care Unit: Findings from a Retrospective Mortality
Qalab Abbas1, Fozia Memon2, Parveen Laghari2
1Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK.
Insights
Potentially preventable deaths in critically ill children are often linked to diagnostic errors and hospital-acquired infections. Improving care processes and clinical decision support can reduce pediatric intensive care unit mortality.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Patient Safety
Background:
- Potentially preventable mortality in pediatric intensive care units (PICUs) remains a significant concern.
- Understanding the causes of these deaths is crucial for developing effective safety interventions.
Purpose of the Study:
- To estimate the proportion and identify the causes of potentially preventable mortality in critically ill children admitted to the PICU.
- To evaluate the role of delayed recognition, interventions, and hospital-acquired infections in pediatric deaths.
Main Methods:
- A retrospective review of medical records for all patients who died in the PICU between January 2014 and December 2015.
- Independent reviewer assessment of records using a 6-point scale to determine preventability, focusing on diagnostic errors, intervention delays, and hospital-acquired infections.
Main Results:
- Of 690 deaths, 92 were analyzed. None had definitive evidence of preventability.
- 4.3% were possibly preventable (>50/50 chance), 16.3% possibly preventable (<50/50 chance), 30.4% had some evidence of preventability, and 49.0% were not preventable.
- Hospital-acquired infections (52.6%), slow intervention (31.6%), and late diagnostic identification (21.0%) were associated with potentially preventable deaths.
Conclusions:
- Preventable diagnostic errors and nosocomial infections are significant contributors to mortality in critically ill children.
- Structured mortality analysis offers actionable insights for future preventive strategies.
- Enhancing care processes and implementing clinical decision support systems may reduce preventable mortality rates.
Abstract:
Objective The goal of this study was to estimate the proportion and causes of potentially preventable mortality among critically ill children admitted to the pediatric intensive care unit (PICU). Methods The medical records of all patients who died in the PICU (age range: one month to 16 years) between January 2014 and December 2015 were evaluated by two independent reviewers to determine whether there had been any delayed recognition of deteriorating conditions, delayed interventions, unintentional/unanticipated harm, medication errors, adverse reactions to transfusions, and hospital-acquired infections that could have resulted in unanticipated death. Preventability was labeled on a 6-point scale. Results During the study period, 92 of 690 patients did not survive [median age: 60 months, interquartile range (IQR): 114]. The median Pediatric Risk of Mortality (PRISM) III score was 17 (IQR: 6). Major diagnostic categories included sepsis (n = 29, 35%), central nervous system diseases (n = 16, 17%), oncological/hematological diseases (n = 6, 6%), cardiac diseases (n = 4, 4%), and miscellaneous conditions. None of the deaths had definitive or strong evidence of preventability. Four (4.3%) patients were in category 4 (i.e., possibly preventable, >50/50 chance), 15 (16.3%) in category 3 (possibly preventable, <50/50 chance), 28 (30.4%) had some evidence of preventability, and 45 (49.0%) were labeled as definitely not preventable. Late identification (diagnostic error) of the worsening condition in four (21.0%) patients, slow intervention in six (31.6.0%), and hospital-acquired infections in 10 (52.6%) were found to be related to potentially preventable mortality. Conclusions Preventable diagnostic errors and nosocomial infections (NIs) are major contributors to preventable mortality. Structured mortality analysis provides actionable information for future preventive strategies. Improvement in care processes, including clinical decision support systems, could help reduce preventable mortality rates.
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