Critical incidents in paediatric critical care: who is at risk?

Abstract

We evaluated the characteristics of children for whom critical incidents (CIs) were reported by performing prospective collection of patient data and retrospective review of reported CIs in a multidisciplinary neonatal-paediatric intensive care unit of a tertiary care university children's hospital. A period of 1 year was analysed (January to December 2007; 1,251 admissions). CIs comprised adverse events (actual patient injury), as well as near-misses. The report form of critical incidents was web-based and reporting was voluntary, anonymous and non-punitive. The severity of all CIs was divided into minor, moderate and major. Patients with and without CIs were compared regarding the following characteristics: Paediatric Index of Mortality (PIM2), duration of mechanical ventilation, length of stay in the intensive care, admission mode (surgery, cardiopulmonary bypass, cardiac/non-cardiac unit), age and sex. There were 360 CI reports (83 per 1,000 patient days; 13% major, 26% moderate, 61% minor severity). Of these, 310 CIs could be assigned to 198 specific patients. In the univariate analysis, patient-related risk factors for CIs were higher PIM2 score (p < 0.0001), increased length of stay (p < 0.0001), mechanical ventilation (p < 0.0001), increased ventilator days (p < 0.0001), male gender (p = 0.022) and young age (p < 0.0001). Using a logistic regression model, mechanical ventilation (p < 0.0001), male gender (p = 0.034) and length of stay (p < 0.0001) continued to be associated with the occurrence of CIs. Conclusion CIs often occur in paediatric intensive care. Among the patient-related factors, male gender, mechanical ventilation, and length of stay are independently associated with CIs. Already known at admission to intensive care are male gender and, usually, requirement for mechanical ventilation. Improved knowledge of the risk factors for CIs could help to minimize their frequency and thus improve quality of care.

The Pediatric Index of Mortality as a Trigger Tool for the Detection of Serious Errors and Adverse Events*

“…Younger patients and patients with prolonged ventilator dependence were at higher risks of SEAEs. This finding is in accordance with the literature evaluating safety incidents in the PICU (21,22). Previous studies have established harm rates of 0.37 (9) and 0.40 (7) per admission using trigger lists to identify the most common causes of harm in pediatric inpatient environments.…”

Medical errors in neonatal intensive care unit at Benha University Hospital, Egypt

“…In our study, minor errors were the most common, followed by moderate and severe errors. This agrees with a study that reported 61% minor errors, 26% moderate errors and 13% major errors (11). However, our results disagree with another study that reported 30% major errors (death or need for ICUspecific intervention), 25% moderate errors (requiring routine therapy available outside the ICU) and 45% minor errors (no intervention required) (27).…”

The occurrence of adverse events in low-risk non-survivors in pediatric intensive care patients: an exploratory study

“…The incidence of AEs in the PICU population depends on the method used to detect AEs [1, 17, 19, 22, 28, 31, 33, 36]. Studies using a trigger tool method show that 59–76% of all PICU patients encounter at least one AE during their stay [1, 17, 36].…”

“…Although one could speculate that AE incidence is higher in the more complex and sicker patients needing extensive support (high-risk patients), AEs also occur in the less severely ill PICU patients [1, 17, 22]. To our knowledge, no studies have focused on the occurrence of AEs in low-risk PICU patients.…”

“…Because of their vulnerability, intensive care patients are more prone to iatrogenic events [ 10 , 12 , 13 ]. The incidence of AEs in the PICU population depends on the method used to detect AEs [ 1 , 17 , 19 , 22 , 28 , 31 , 33 , 36 ]. Studies using a trigger tool method show that 59–76% of all PICU patients encounter at least one AE during their stay [ 1 , 17 , 36 ].…”