National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 89 Research Studies DisplayedIantorno SE, Scaife JH, Bryce JR
Emergency department utilization for pediatric gastrostomy tubes across the United States.
This study investigated the number and nature of emergency department (ED) visits to community hospitals for pediatric gastrostomy tube complication. The authors used the 2019 Nationwide Emergency Department Sample to perform a retrospective cross-sectional analysis of pediatric patients (<18 y) with a primary diagnosis of gastrostomy tube complication. Their primary outcome was a potentially preventable ED visit, defined as an encounter that did not result in any imaging, procedures, or an inpatient admission. They observed 32,036 ED visits at 535 hospitals and 15,165 (47.3%) were potentially preventable. Median age was 2 years, and 17,707 (55%) were male. Compared to White patients, patients with higher odds of potentially preventable visits were Black and Hispanic. Patients with residential zip codes in the first, second, and third median household income quartiles had higher odds of potentially preventable visits compared to the highest.
AHRQ-funded; HS025776.
Citation: Iantorno SE, Scaife JH, Bryce JR .
Emergency department utilization for pediatric gastrostomy tubes across the United States.
J Surg Res 2024 Mar; 295:820-26. doi: 10.1016/j.jss.2023.11.028.
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Healthcare Utilization, Surgery, Adverse Events
Loi MV, Lee JH, Huh JW
Ketamine use in the intubation of critically ill children with neurological indications: a multicenter retrospective analysis.
This study examined use of ketamine in children undergoing tubal intubation (TI) for a primary neurological indication. The authors conducted a retrospective observational cohort study of critically ill children undergoing TI for neurological indications in 53 international pediatric intensive care units and emergency departments. They screened all intubations from 2014 to 2020 entered into the multicenter National Emergency Airway Registry for Children (NEAR4KIDS) registry database. Of 21,562 TIs, 2,073 were performed for a primary neurological indication, including 190 for traumatic brain injury/trauma. Patients received ketamine in 495 TIs (23.9%), which increased from 10% in 2014 to 41% in 2020. Criteria for ketamine use includes a coindication of respiratory failure, difficult airway history, and use of vagolytic agents, apneic oxygenation, and video laryngoscopy. Composite adverse outcomes were reported in 289 (13.9%) TIs and were more common in the ketamine group (17.0% vs. 13.0%). After adjusting for location, patient age and co-diagnoses, the presence of respiratory failure and shock, difficult airway history, provider demographics, intubating device, and the use of apneic oxygenation, vagolytic agents, and neuromuscular blockade, ketamine use was not significantly associated with increased composite adverse outcomes. This paucity of association remained even when only neurotrauma intubations were considered (10.6% vs. 7.7%).
AHRQ-funded; HS022464, HS024511.
Citation: Loi MV, Lee JH, Huh JW .
Ketamine use in the intubation of critically ill children with neurological indications: a multicenter retrospective analysis.
Neurocrit Care 2024 Feb; 40(1):205-14. doi: 10.1007/s12028-023-01734-0.
Keywords: Children/Adolescents, Critical Care, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Carroll AR, Johnson JA, Stassun JC
Health literacy-informed communication to reduce discharge medication errors in hospitalized children: a randomized clinical trial.
This study’s objective was to test a health literacy-informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children. This parallel, randomized clinical trial was conducted from June 22, 2021, to August 20, 2022, at a tertiary care, US children's hospital. English- and Spanish-speaking caregivers of hospitalized children 6 years or younger prescribed a new, scheduled liquid medication at discharge were included in the analysis. Observed dosing errors were the main outcome measured, and secondary outcomes included caregiver-reported medication knowledge. Among 198 randomized caregivers (mean age 31.4 years; 186 women [93.9%]; 36 [18.2%] Hispanic or Latino and 158 [79.8%] White), the primary outcome was available for 151 (76.3%). The observed mean (SD) percentage dosing error was 1.0% (2.2 percentage points) among the intervention group and 3.3% (5.1 percentage points) among the standard counseling group (absolute difference, 2.3 percentage points). Twenty-four of 79 caregivers in the intervention group (30.4%) measured an incorrect dose compared with 39 of 72 (54.2%) in the standard counseling group. The intervention enhanced caregiver-reported medication knowledge compared with the standard counseling group for medication dose (71 of 76 [93.4%] vs 55 of 69 [79.7%]), duration of administration (65 of 76 [85.5%] vs 49 of 69 [71.0%], and correct reporting of 2 or more medication adverse effects (60 of 76 [78.9%] vs 13 of 69 [18.8%]).
AHRQ-funded; HS026122.
Citation: Carroll AR, Johnson JA, Stassun JC .
Health literacy-informed communication to reduce discharge medication errors in hospitalized children: a randomized clinical trial.
JAMA Netw Open 2024 Jan 2; 7(1):e2350969. doi: 10.1001/jamanetworkopen.2023.50969..
Keywords: Children/Adolescents, Health Literacy, Communication, Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Clinician-Patient Communication, Hospital Discharge, Medication: Safety
Kyler KE, Hall M, Antoon JW
Major drug-drug interaction exposure among Medicaid-insured children in the outpatient setting.
This study’s objective was to determine the prevalence of major drug-drug interactions (DDI) exposure and factors associated with higher DDI exposure rates among children in an outpatient setting. The authors performed a cross-sectional study of children aged 0 to 18 years with ≥1 ambulatory encounter, and ≥2 dispensed outpatient prescriptions using the 2019 Marketscan Medicaid database. Primary outcomes were the prevalence and rate of major DDI exposure. Out of 781,019 children with ≥2 medication exposures, 21.4% experienced ≥1 major DDI exposure. The odds of exposure increased with age and with medical and mental health complexity. Frequently mentioned drugs included Clonidine, psychiatric medications, and asthma medications. The highest adverse physiologic effect exposure rate per 100 children included: increased drug concentrations (14.6), central nervous system depression (13.6), and heart rate-corrected QT interval prolongation (9.9).
AHRQ-funded; HS028979.
Citation: Kyler KE, Hall M, Antoon JW .
Major drug-drug interaction exposure among Medicaid-insured children in the outpatient setting.
Pediatrics 2024 Jan; 153(2):e2023063506. doi: 10.1542/peds.2023-063506.
Keywords: Children/Adolescents, Adverse Drug Events (ADE), Adverse Events, Medicaid, Medication: Safety
Giuliano J, Krishna A, Napolitano N
Implementation of video laryngoscope-assisted coaching reduces adverse tracheal intubation-associated events in the PICU.
The purpose of this study was to assess the implementation of a video laryngoscope (VL) as a coaching device to decrease adverse tracheal intubation associated events (TIAEs). Between 2016 and 2020 the researchers implemented VLs as coaching devices with standardized coaching language. Laryngoscopists were encouraged to perform direct laryngoscopy with video images only available in real-time for experienced supervising clinician-coaches. The study found that a VL was used in 71% of 5,060 tracheal intubations. VL utilization increased from a baseline of 29.7% to an implementation phase level of 89.4%. VL utilization was related with lower TIAEs compared with standard laryngoscope (SL). VL utilization was related with lower severe TIAE rate, but not related with a reduction in severe hypoxemia. VL utilization was related with greater first attempt success. In the primary analysis after adjusting for site clustering, VL utilization was related with lower adverse TIAEs. In secondary analyses, VL utilization was not significantly related with severe TIAEs, severe hypoxemia, or first attempt success. After additional controlling for patient and provider characteristics, VL utilization was independently related with a lower TIAE rate.
AHRQ-funded; HS024511.
Citation: Giuliano J, Krishna A, Napolitano N .
Implementation of video laryngoscope-assisted coaching reduces adverse tracheal intubation-associated events in the PICU.
Crit Care Med 2023 Jul; 51(7):936-47. doi: 10.1097/ccm.0000000000005847..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Adverse Events, Patient Safety
Lenz KB, Nishisaki A, Lindell RB
Peri-intubation adverse events in the critically ill child after hematopoietic cell transplant.
The goal of this study was to investigate whether adverse peri-intubation associated events occur at increased frequency in pediatric patients with hematopoietic cell transplant (HCT) compared with non-HCT oncologic or other pediatric ICU (PICU) patients and therefore might contribute to increased mortality. This retrospective cohort study of critically ill children who underwent tracheal intubation (TI) was conducted between 2014 and 2019. Data was merged from local airway management quality databases and Virtual Pediatric Systems. Data was supplemented with a retrospective chart review for HCT-related data, including HCT indication, transplant-related comorbidity status, and patient condition at the time of TI procedure. There was a total of 1,931 children identified who underwent TI, of which 92 (4.8%) were post-HCT, while 319 (16.5%) had history of malignancy without HCT, and 1,520 (78.7%) had neither HCT nor malignancy. Children post-HCT were older, more often had respiratory failure, use of catecholamine infusions peri-intubation, and use of noninvasive ventilation prior to intubation. There was no difference in hemodynamic tracheal intubation-associated adverse events (TIAEs) or peri-intubation hypoxemia across three groups (HCT 16%, non-HCT with malignancy 10%, other 15%). The authors did not find an association between HCT status and the adverse TI outcome after adjusting for age, difficulty airway feature, provider type, device, apneic oxygenation use, and indication for intubation.
AHRQ-funded; HS024511.
Citation: Lenz KB, Nishisaki A, Lindell RB .
Peri-intubation adverse events in the critically ill child after hematopoietic cell transplant.
Pediatr Crit Care Med 2023 Jul; 24(7):584-93. doi: 10.1097/pcc.0000000000003243..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Adverse Events
Kuzma N, Khan A, Rickey L
Effect of Patient and Family Centered I-PASS on adverse event rates in hospitalized children with complex chronic conditions.
This study’s objective was to compare the effect of the intervention Patient and Family Centered (PFC)I-PASS on adverse events (AE) rates in children with and without complex chronic conditions (CCCs). A cohort of 3106 hospitalized children from seven North American pediatric hospitals between December 2014 and January 2017 were included. An effect modification analysis did not show difference in the intervention on children with and without CCCs. There was no statistically significant change in AEs for children with or without CCCs.
AHRQ-funded; HS022986.
Citation: Kuzma N, Khan A, Rickey L .
Effect of Patient and Family Centered I-PASS on adverse event rates in hospitalized children with complex chronic conditions.
J Hosp Med 2023 Apr;18(4):316-20. doi: 10.1002/jhm.13065.
Keywords: Children/Adolescents, Patient-Centered Healthcare, Chronic Conditions, Adverse Events, Inpatient Care, Transitions of Care
Wong CI, Vannatta K, Gilleland Marchak J
Preventable harm because of outpatient medication errors among children with leukemia and lymphoma: a multisite longitudinal assessment.
The goal of this longitudinal study was to characterize rates and types of medication errors and harm to outpatient children with leukemia and lymphoma over seven months of treatment. The study included children taking medications at home for leukemia or lymphoma from three pediatric cancer centers. Ten percent experienced adverse drug events because of outpatient medication errors. Twenty-six percent of caregivers reported miscommunication leading to missed doses or overdoses. The authors concluded that improvements addressing communication with and among caregivers should be based on human-factors engineering and codeveloped with families.
AHRQ-funded; HS024390.
Citation: Wong CI, Vannatta K, Gilleland Marchak J .
Preventable harm because of outpatient medication errors among children with leukemia and lymphoma: a multisite longitudinal assessment.
Cancer 2023 Apr 1;129(7):1064-74. doi: 10.1002/cncr.34651.
Keywords: Children/Adolescents, Cancer, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Ambulatory Care and Surgery, Medication: Safety, Patient Safety
Difazio RL, Shore BJ, Melvin P
Pneumonia after hip surgery in children with neurological complex chronic conditions.
The purpose of this retrospective cohort study was to estimate rates of postoperative pneumonia in children with neurological complex chronic conditions (CCC) undergoing hip surgery, to determine the effect of pneumonia on postoperative hospital resource use, and to identify predictors. Researchers used data from the Pediatric Health Information System for children 4 years and older with a neurological CCC who had undergone hip surgery from 2016 to 2018 in U.S. children's hospitals. Findings indicate that postoperative pneumonia in children with a neurological CCC was associated with longer length-of-stay, readmissions, and higher costs. Children who had undergone pelvic osteotomies and who had multimorbidity needed additional clinical support to prevent postoperative pneumonia and to decrease resource utilization.
AHRQ-funded; HS024453.
Citation: Difazio RL, Shore BJ, Melvin P .
Pneumonia after hip surgery in children with neurological complex chronic conditions.
Dev Med Child Neurol 2023 Feb; 65(2):232-42. doi: 10.1111/dmcn.15339..
Keywords: Children/Adolescents, Surgery, Neurological Disorders, Pneumonia, Respiratory Conditions, Hospital Readmissions, Adverse Events
Napolitano N, Polikoff L, Edwards L
Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children.
This study’s goal was to determine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI) reduces adverse TI-associated events (TIAEs) in children. AO was implemented at 14 pediatric intensive care units as a quality improvement intervention from 2016 through 2020. Implementation consisted of an intubation safety checklist, leadership endorsement, use of a local champion, and data feedback to frontline clinicians. Of 6549 TIs during the study period, 2554 occurred during the pre-implementation phase and 3995 during post-implementation phase. AO utilization increased from 23 to 68%. It was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patients intubated due to respiratory or neurological failure or shock. Conversely, it was used more often in TIs done for procedures or those associated by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs. without AO 13.5%). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs, and the occurrence of hypoxemia was not different (AO 14.2% versus without AO 15.2%).
AHRQ-funded; HS024511.
Citation: Napolitano N, Polikoff L, Edwards L .
Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children.
Crit Care 2023 Jan 17; 27(1):26. doi: 10.1186/s13054-023-04304-0..
Keywords: Children/Adolescents, Critical Care, Adverse Events, Respiratory Conditions
Encinosa W, Moon K, Figueroa J
AHRQ Author: Encinosa W
Complications, adverse drug events, high costs, and disparities in multisystem inflammatory syndrome in children vs COVID-19.
This cross-sectional study’s goal was to determine outcomes from multisystem inflammatory syndrome in children (MIS-C) after COVID-19. Outcomes examined were 50 complications, adverse medication events, costs, and the Social Vulnerability Index. An analysis was conducted using data from the 2021 HCUP in individuals younger than 21 years from 31 states. There were 4107 individuals hospitalized with MIS-C (median age 9 years, 59.5% male, 38.1% White) and 23,686 hospitalizations for COVID-19 without MIS-C (median age 15 years, 54.5% female, 44.1% White). Hospitalization rate for MIS-C was 1.48 per 100,000 children, ranging from 0.97 hospitalizations per 100 for White and 1.99 hospitalizations per 100 for Black children. Outcomes were worse when organ dysfunction increased from 2 to 8 organs, with deaths increasing from less than 1% to 5.8% for MIS-C, and 1% to 17.2% for COVID-19. Median length of stay increased from 4 to 8 days for MIS-C, and 3 to 16 days for COVID-19. Median costs for MIS-C increased from $16,225 to $53 359 and from $6474 to $98,643 for COVID-19. The percentage of MIS-C cases in Black children doubled from 16.2% to 31.7% as organ dysfunction increased, remaining unchanged with COVID-19.
AHRQ-authored.
Citation: Encinosa W, Moon K, Figueroa J .
Complications, adverse drug events, high costs, and disparities in multisystem inflammatory syndrome in children vs COVID-19.
JAMA Netw Open 2023 Jan;6(1):e2244975. doi: 10.1001/jamanetworkopen.2022.44975..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, COVID-19, Medication, Adverse Drug Events (ADE), Adverse Events, Healthcare Costs, Disparities, Racial and Ethnic Minorities
Pineles BL, Harris AD, Goodman KE
Adverse maternal and delivery outcomes in children and very young (age ≤13 years) US adolescents compared with older adolescents and adults.
This study compared adverse maternal and delivery outcomes of pregnant 10- to 13-year-olds vs 14- to 17-year-olds and 18- to 19-year-olds. This cross-sectional study looked at all patients aged 10 to 19 years who delivered at hospitals in the Premier Healthcare Database from January 2019 through May 2021. The study included 90,876 deliveries across 655 US hospitals. Controlling for patient race and ethnicity, insurance type, and obesity status: 10- to 13-year-olds had significantly higher risks of preterm delivery and cesarean delivery compared with 14- to 17-year-olds. The risk of preeclampsia was not higher for 10- to 13-year-olds compared to 14- to 17-year-olds. There was a higher risk of preterm delivery for 10- to 13-year-olds compared to 18- to 19-year-olds, but not significantly different for cesarean delivery and preeclampsia.
AHRQ-funded; HS028363.
Citation: Pineles BL, Harris AD, Goodman KE .
Adverse maternal and delivery outcomes in children and very young (age ≤13 years) US adolescents compared with older adolescents and adults.
JAMA 2022 Nov 1;328(17):1766-68. doi: 10.1001/jama.2022.18340..
Keywords: Children/Adolescents, Pregnancy, Labor and Delivery, Women, Outcomes, Adverse Events, Maternal Care
Halvorson EE, Thurtle DP, Easter A
Disparities in adverse event reporting for hospitalized children.
The authors compared the adverse event (AE) rate identified by voluntary event reporting (VER) with that identified using the Global Assessment of Pediatric Patient Safety (GAPPS) between hospitalized children by weight category, race, and English proficiency. In the population studied, they identified 288 total AEs, 270 by the GAPPS and 18 by VER. They found a disparity in AE reporting for children with limited English proficiency, with fewer AEs by VER compared with no difference in AEs by GAPPS. They identified no disparities by weight category or race. They concluded that voluntary event reporting may systematically underreport AEs in hospitalized children with limited English proficiency.
AHRQ-funded; HS026038.
Citation: Halvorson EE, Thurtle DP, Easter A .
Disparities in adverse event reporting for hospitalized children.
J Patient Saf 2022 Sep 1;18(6):e928-e33. doi: 10.1097/pts.0000000000001049..
Keywords: Children/Adolescents, Disparities, Adverse Events, Medical Errors, Patient Safety, Hospitals, Hospitalization, Inpatient Care
Mercer AN, Mauskar S, Baird J
Family safety reporting in hospitalized children with medical complexity.
This prospective cohort study was conducted to evaluate safety concerns from families of hospitalized children with medical complexity (CMC) who are at high risk of medical errors. This survey was done predischarge with English- and Spanish-speaking parents/staff of hospitalized CMC on 5 units caring for complex care patients at a tertiary care children's hospital. A total of 155 parents and 214 staff completed surveys, with 43% (n = 66) having ≥1 hospital safety concerns, totaling 115 concerns (1-6 concerns each). A physician review found that 69% of concerns were medical errors, and 22% nonsafety-related quality issues. Most parents (68%) reported concerns to staff, particularly bedside nurses, but only 32% of parents recalled being told how to report safety concerns. Higher education and longer length of stay were associated with family safety concerns.
AHRQ-funded; HS025781.
Citation: Mercer AN, Mauskar S, Baird J .
Family safety reporting in hospitalized children with medical complexity.
Pediatrics 2022 Aug 1; 150(2):e2021055098. doi: 10.1542/peds.2021-055098..
Keywords: Children/Adolescents, Family Health and History, Chronic Conditions, Patient Safety, Medical Errors, Adverse Events, Inpatient Care
Khan A, Baird J, Kelly MM
Family safety reporting in medically complex children: parent, staff, and leader perspectives.
This qualitative study examined parent, staff, and hospital leader perspectives about family safety reporting in children with medical complexity (CMC) to inform future interventions. The study was conducted at 2 tertiary care children’s hospitals with dedicated inpatient complex care services. Hour-long semi-structured, individual interviews were conducted with English and Spanish-speaking parents of CMC, physicians, nurses, and hospital leaders. A total of 80 participants (34 parents, 19 nurses and allied health professionals, 11 physicians, and 16 hospital leaders) were interviewed. Four themes related to family safety reporting emerged: (1) unclear, nontransparent, and variable existing processes, (2) a continuum of staff and leadership buy-in, (3) a family decision-making calculus about whether to report, and (4) misaligned staff and parent priorities and expectations. The authors also identified potential strategies for engaging families and staff in family reporting.
AHRQ-funded; HS025781.
Citation: Khan A, Baird J, Kelly MM .
Family safety reporting in medically complex children: parent, staff, and leader perspectives.
Pediatrics 2022 Jun; 149(6). doi: 10.1542/peds.2021-053913..
Keywords: Children/Adolescents, Family Health and History, Chronic Conditions, Provider: Physician, Patient Safety, Medical Errors, Adverse Events, Inpatient Care
Eisenberg MT, Block AM, Vopat ML
Rates of infection after ACL reconstruction in pediatric and adolescent patients: a MarketScan database study of 44,501 patients.
This study’s objective was to describe and analyze the rates of surgical site infections after anterior cruciate ligament (ACL) surgery in pediatric patients. The Truven Health Analytics MarketScan Commercial Claims and Encounters database was used to access data for privately insured individuals aged 5 to 30 years old. ACL reconstruction operation records were accessed for operations performed from 2006 to 2018. The database identified 44,501 individuals up to 18 years old, and 63,495 individuals aged 18 to 30 years old that underwent arthroscopic ACL reconstruction. No differences in infection rates were found between the two groups. However, among patients younger than 18 years, patients below 15 years old had a significantly lower infection rate at 0.37% compared with adolescents 15 to 17 years old at 0.55%. Among young adults, males had a higher infection rate than females, while no differences were observed in the pediatric and adolescent population.
AHRQ-funded; HS019455.
Citation: Eisenberg MT, Block AM, Vopat ML .
Rates of infection after ACL reconstruction in pediatric and adolescent patients: a MarketScan database study of 44,501 patients.
J Pediatr Orthop 2022 Apr;42(4):e362-e66. doi: 10.1097/bpo.0000000000002080..
Keywords: Children/Adolescents, Surgery, Orthopedics, Healthcare-Associated Infections (HAIs), Adverse Events, Injuries and Wounds
Ing C, Landau R, DeStephano D
Prenatal exposure to general anesthesia and childhood behavioral deficit.
This study looked at the association of prenatal exposure to general anesthesia and childhood behavioral deficits. The Raine Study was an observational cohort study of children born in Perth, Western Australia with 2 generations of participations. The first generation (Gen1) were mothers enrolled during pregnancy, and the second generation (Gen2) were the children born from 1989 to 1992 with neuropsychological and behavioral tests evaluated at age 10. Six neuropsychological and behavioral tests were used with the Child Behavior Checklist (CBCL) as the main test. Among 2024 children with available outcome scores, 22 were prenatally exposed to general anesthesia. These children had higher CBCL Externalizing behavioral scores than unexposed children. Of the six tests used, only CBCL Externalizing behavioral scores remained significant after multiple comparisons adjustment.
AHRQ-funded; HS026493.
Citation: Ing C, Landau R, DeStephano D .
Prenatal exposure to general anesthesia and childhood behavioral deficit.
Anesth Analg 2021 Sep 1;133(3):595-605. doi: 10.1213/ane.0000000000005389..
Keywords: Children/Adolescents, Behavioral Health, Pregnancy, Adverse Drug Events (ADE), Adverse Events
Cifra CL, Custer JW, Singh H
Diagnostic errors in pediatric critical care: a systematic review.
This study is a systematic review on the prevalence, impact, and contributing factors related to diagnostic errors in the PICU. A database search was done for literature up through December 2019. Using specific criteria, 396 abstracts were screened, and 17 studies were included. Fifteen of 17 studies had an observational research design. Autopsy studies showed a 10-23% rate of missed major diagnosis with 5-16% of the errors having a potential adverse impact on survival and would have changed care management. Retrospective record review studies reported varying rates of diagnostic error from 8% in a general PICU population to 12% among unexpected critical admissions. About a quarter of those patients were discussed at PICU morbidity and mortality conferences. Most misdiagnosed conditions were cardiovascular, infectious, congenital, or neurologic. System, cognitive, and both system and cognitive factors were associated with diagnostic error but there is limited information on the impact of misdiagnosis.
AHRQ-funded; HS026965.
Citation: Cifra CL, Custer JW, Singh H .
Diagnostic errors in pediatric critical care: a systematic review.
Pediatr Crit Care Med 2021 Aug;22(8):701-12. doi: 10.1097/pcc.0000000000002735..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Intensive Care Unit (ICU), Critical Care
Worsham CM, Woo J, Jena AB
Adverse events and emergency department opioid prescriptions in adolescents.
Understanding the risks associated with opioid prescription in adolescents is critical for informing opioid policy, but the risks are challenging to quantify given the lack of randomized trial data. Using a regression discontinuity design, the investigators exploited a discontinuous increase in opioid prescribing in the emergency department (ED) when adolescents transitioned from "child" to "adult" at age eighteen to estimate the effect of an ED opioid prescription on subsequent opioid-related adverse events.
AHRQ-funded; HS026753.
Citation: Worsham CM, Woo J, Jena AB .
Adverse events and emergency department opioid prescriptions in adolescents.
Health Aff 2021 Jun;40(6):970-78. doi: 10.1377/hlthaff.2020.01762..
Keywords: Children/Adolescents, Emergency Department, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Practice Patterns
Masonbrink AR, Harris M, Hall M
Safety events in children's hospitals during the COVID-19 pandemic.
The coronavirus disease 2019 (COVID-19) pandemic has impacted hospitals, potentially affecting quality and safety. The objective of this study was to compare pediatric hospitalization safety events during the pandemic versus previous years. The investigators concluded that postoperative sepsis rates increased among children hospitalized during COVID-19. They suggest that efforts are needed to improve safety of postoperative care for hospitalized children.
AHRQ-funded; HS024554; HS024592.
Citation: Masonbrink AR, Harris M, Hall M .
Safety events in children's hospitals during the COVID-19 pandemic.
Hosp Pediatr 2021 Jun;11(6):e95-e100. doi: 10.1542/hpeds.2020-004937..
Keywords: Children/Adolescents, COVID-19, Patient Safety, Sepsis, Adverse Events, Hospitalization, Hospitals, Inpatient Care, Infectious Diseases, Public Health
Michelson KA, Dart AH, Bachur RG
Measuring complications of serious pediatric emergencies using ICD-10.
The purpose of this study was to create definitions for complications for 16 serious pediatric conditions using the International Classification of Diseases, 10th Revision, Clinical Modification or Procedure Coding System (ICD-10-CM/PCS), and to assess whether complication rates are similar to those measured with ICD-9-CM/PCS. The investigators concluded that for most conditions, incidences and complication rates were similar before and after the transition to ICD-10-CM/PCS codes, suggesting their system identified complications of conditions in administrative data similarly using ICD-9-CM/PCS and ICD-10-CM/PCS codes.
AHRQ-funded; HS026503.
Citation: Michelson KA, Dart AH, Bachur RG .
Measuring complications of serious pediatric emergencies using ICD-10.
Health Serv Res 2021 Apr;56(2):225-34. doi: 10.1111/1475-6773.13615..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Adverse Events
Horton DB, Xie F, Chen L
Oral glucocorticoids and incident treatment of diabetes mellitus, hypertension, and venous thromboembolism in children.
The purpose of this study was to quantify rates of incident treatment for diabetes mellitus, hypertension, and venous thromboembolism (VTE) associated with oral glucocorticoid exposure in children aged 1-18 years. Participants were identified using US Medicaid claims data and included more than 930,000 children diagnosed with autoimmune diseases or a nonimmune comparator condition. Findings showed strong dose-dependent relationships between current glucocorticoid exposure and all outcomes, suggesting strong relative risks, but low absolute risks, of newly-treated VTE, diabetes, and especially hypertension in children taking high-dose oral glucocorticoids.
AHRQ-funded; HS021110.
Citation: Horton DB, Xie F, Chen L .
Oral glucocorticoids and incident treatment of diabetes mellitus, hypertension, and venous thromboembolism in children.
Am J Epidemiol 2021 Feb 1;190(3):403-12. doi: 10.1093/aje/kwaa197..
Keywords: Children/Adolescents, Diabetes, Chronic Conditions, Blood Clots, Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Patient Safety, Blood Pressure
Ing C, Jackson WM, Zaccariello MJ
Prospectively assessed neurodevelopmental outcomes in studies of anaesthetic neurotoxicity in children: a systematic review and meta-analysis.
This systematic review and meta-analysis tried to answer the question whether exposure to a single general anesthetic (GA) in early childhood causes long-term neurodevelopmental problems. Databases searched from inception to October 2019 were PubMed/MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library. Outcomes common to at least three studies were evaluated using a random-effects meta-analyses. A total of 841 out of 1644 children who had a single exposure to GA were evaluated. Findings were that there were statistically significant increases in parent reports of behavioral problems but no difference in general intelligence.
AHRQ-funded; HS026493.
Citation: Ing C, Jackson WM, Zaccariello MJ .
Prospectively assessed neurodevelopmental outcomes in studies of anaesthetic neurotoxicity in children: a systematic review and meta-analysis.
Br J Anaesth 2021 Feb;126(2):433-44. doi: 10.1016/j.bja.2020.10.022..
Keywords: Children/Adolescents, Neurological Disorders, Medication, Adverse Drug Events (ADE), Adverse Events, Evidence-Based Practice, Outcomes
Marshall TL, Ipsaro AJ, Le M
Increasing physician reporting of diagnostic learning opportunities.
This study investigated methods to improve physician reporting of diagnostic errors at the pediatric division of a hospital. In that pediatric hospital medicine (PHM) division only 1 diagnostic-related safety event was reported in the preceding 4 years. The authors aimed to improve attending physician reporting of suspected diagnostic errors from 0 to 2 per 100 PHM patient admissions within 6 months. The improvement team used the Model for Improvement and used the term diagnostic learning opportunity (DLO) with clinicians as opposed to diagnostic error to lessen the stigma. They developed an electronic reporting form and encouraged its use through reminders, scheduled reflection time, and monthly progress reports. Over the course of 13 weeks, there was an increase from 0 to 1.6 per patient admission reports files. Most events (66%) were true diagnostic errors.
AHRQ-funded; HS023827.
Citation: Marshall TL, Ipsaro AJ, Le M .
Increasing physician reporting of diagnostic learning opportunities.
Pediatrics 2021 Jan;147(1). doi: 10.1542/peds.2019-2400..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Hospitals, Quality Improvement, Quality of Care
Branca A, Tellez D, Berkenbosch J
The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children.
Researchers evaluated the effect of the timing of the PICU fellow academic cycle on tracheal intubation-associated events in a retrospective cohort study of 37 PICUs participating in the National Emergency Airway Registry for Children.. They found that the New Trainee Effect in tracheal intubation safety outcomes was not observed in various types of PICUs. There was a significant improvement in pediatric critical care medicine fellows' first attempt success and a significant decline in tracheal intubation-associated event rates, indicating substantial skills acquisition throughout pediatric critical care medicine fellowship.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Branca A, Tellez D, Berkenbosch J .
The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children.
Pediatr Crit Care Med 2020 Dec;21(12):1042-50. doi: 10.1097/pcc.0000000000002480..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Patient Safety, Registries, Education: Continuing Medical Education, Training