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

Rüegger, Christoph M.; Frey, Bernhard

doi:10.1097/pcc.0000000000001654

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…The results of the present study are consistent with our previous study and with another single-center study on LN ( 14 , 15 ). In the study by Ruegger ( 15 ), LN had four times more AEs than LS, although the cut off point for “low-risk” (PIM2 mortality risk < 10%) was different compared with our study. LN seem to be associated with serious AEs, including preventable AEs.…”

Section: Discussionsupporting

confidence: 94%

“…First, there is no gold-standard for low risk for mortality ( 12 , 15 ). A combination of low PIM2 and/or low PRISM mortality risk was used to classify low risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

Verlaat

Zegers

Waardenburg

et al. 2022

Pediatric Critical Care Medicine

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OBJECTIVES: Some patients with a low predicted mortality risk in the PICU die. The contribution of adverse events to mortality in this group is unknown. The aim of this study was to estimate the occurrence of adverse events in low-risk nonsurvivors (LN), compared with low-risk survivors (LS) and high-risk PICU survivors and nonsurvivors, and the contribution of adverse events to mortality. DESIGN: Case control study. Admissions were selected from the national Dutch PICU registry, containing 53,789 PICU admissions between 2006 and 2017, in seven PICUs. PICU admissions were stratified into four groups, based on mortality risk (low/high) and outcome (death/survival). Random samples were selected from the four groups. Cases were “LN.” Control groups were as follows: “LS,” “high-risk nonsurvivors” (HN), and “high-risk survivors” (HS). Adverse events were identified using the validated trigger tool method. SETTING: Patient chart review study. PATIENTS: Children admitted to the PICU with either a low predicted mortality risk (< 1%) or high predicted mortality risk (≥ 30%). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In total, 419 patients were included (102 LN, 107 LS, 104 HN, and 106 HS). LN had more complex chronic conditions (93.1%) than LS (72.9%; p < 0.01), HN (49.0%; p < 0.001), and HS (48.1%; p < 0.001). The occurrence of adverse events in LN (76.5%) was higher than in LS (13.1%) and HN (47.1%) ( p < 0.001). The most frequent adverse events in LN were hospital-acquired infections and drug/fluid-related adverse events. LN suffered from more severe adverse events compared with LS and HS ( p < 0.001). In 30.4% of LN, an adverse event contributed to death. In 8.8%, this adverse event was considered preventable. CONCLUSIONS: Significant and preventable adverse events were found in low-risk PICU nonsurvivors. 76.5% of LN had one or more adverse events. In 30.4% of LN, an adverse event contributed to mortality.

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Section: Discussionsupporting

confidence: 94%

“…First, there is no gold-standard for low risk for mortality ( 12 , 15 ). A combination of low PIM2 and/or low PRISM mortality risk was used to classify low risk patients.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Verlaat

Zegers

Waardenburg

et al. 2022

Pediatric Critical Care Medicine

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“…( 17 ) PIM-2, when used as a trigger for AE prediction, yielded easy and fast identification of patients at risk of AEs. ( 27 )…”

Section: Discussionmentioning

confidence: 99%

Adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit: the contribution of the VIS score and the RACHS-1

Wasniewski,

Ricachinevsky,

Rezende

et al. 2023

Crit Care Sci

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Objective To evaluate the occurrence of adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit and to find any patient characteristics that can predict such events. Methods This was a historical cohort study of patients recovering in the pediatric intensive care unit for the first 7 days after cardiac surgery between April and December 2019, by reviewing the medical records. The following were reviewed: demographic, clinical, and laboratory characteristics; patient severity scores; and selected adverse events, grouped into device-related, surgical, and nonsurgical. Results A total of 238 medical records were included. At least one adverse event occurred in 110 postoperative patients (46.2%). The total number of adverse events was 193 (81%). Vascular catheters were the most common cause, followed by cardiac arrest, bleeding, and surgical reexploration. In the univariate analysis, the vasoactive-inotropic score (VIS), Risk Adjustment in Congenital Heart Surgery (RACHS-1) score, age, Pediatric Index of Mortality (PIM-2), cardiopulmonary bypass and aortic clamping duration were significantly associated with adverse events. In the multivariate analysis, VIS ≥ 20 (OR 2.90; p = 0.004) and RACHS-1 ≥ 3 (OR 2.11; p = 0.019) were significant predictors, while age and delayed sternal closure showed only trends toward significance. To predict the occurrence of adverse events from VIS and RACHS-1, the area under the curve was 0.73 (95%CI 0.66 - 0.79). Conclusion Adverse events were quite frequent in children after cardiac surgery, especially those related to devices. The VIS and RACHS-1, used together, predicted the occurrence of adverse events well in this pediatric sample.

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A mixed methods study to effectively utilize trigger tools in the ICU

Lip

Stelfox

2021

Journal of Critical Care

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

Cited by 4 publications

References 34 publications

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

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

Adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit: the contribution of the VIS score and the RACHS-1

A mixed methods study to effectively utilize trigger tools in the ICU

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