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

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. Electronic supplementary materialThe online version of this article (10.1007/s00431-018-3194-y) contains supplementary material, which is available to authorized users.

Associations between healthcare environment design and adverse events in intensive care unit

“…The findings revealed a low incidence rate of AEs, about 11%, in all of the examined patient rooms. This is a lower incidence than what prior research has reported, 2‐4 also in Swedish settings of critical care 41,42 . There were no findings in this study that indicated that the intervention room had any significant effect on decreasing the number of AEs for the critically ill patients assigned to the refurbished room.…”

“…An AE is defined as an injury related to medical management that may be either preventable or non‐preventable 1 . Unfortunately, AEs are relatively common with incidence rates ranging from 29% to 83% in intensive care settings, 2‐4 and they have serious consequences, including death, among already vulnerable patients with life‐threatening conditions. However, AEs are often preventable, and an improved healthcare environment could support and reduce the number of AEs.…”

“…An AE is defined as an injury related to medical management that may be either preventable or non‐preventable 1 . The AE prevalence among ICU patients is relatively high with an incidence rate of 29%‐83% 2‐4 . Moreover, AEs have serious consequences because patients in the ICU are already in an extremely delicate situation and facing life‐threatening illnesses or conditions 19‐21 .…”

Problems in care and avoidability of death after discharge from intensive care: a multi-centre retrospective case record review study

“…Our sample size was larger than in similar studies of specific patient cohorts [ 44 – 46 ] but smaller than in previous work focused on general hospital populations, where a smaller proportion of deaths were anticipated to be modifiable [ 9 , 11 ]. As a result, our estimates of the rates of avoidable deaths have relatively wide confidence intervals.…”

Adverse Events in Pediatric Critical Care Nonsurvivors With a Low Predicted Mortality Risk: A Multicenter Case Control Study*

“…Specifically, the contribution of AEs in these “unexpected deaths” is unknown but of great interest. Although one may expect that AEs mainly occur in the most complex, critically ill PICU patients, two small studies showed that low-risk PICU patients who die have a high occurrence of AEs ( 14 , 15 ). In order to gain more insight into the occurrence and relevance of AEs in low-risk PICU nonsurvivors, we performed a nation-wide study in The Netherlands.…”