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Topics
- Adverse Drug Events (ADE) (5)
- (-) Adverse Events (23)
- Ambulatory Care and Surgery (1)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Behavioral Health (1)
- Cancer (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- (-) Children/Adolescents (23)
- Critical Care (5)
- Decision Making (1)
- Diagnostic Safety and Quality (2)
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- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Hospitalization (1)
- Hospitals (2)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (7)
- Medical Errors (2)
- Medication (5)
- Medication: Safety (2)
- Mortality (1)
- Obesity (1)
- Opioids (1)
- Outcomes (2)
- Patient Safety (13)
- Policy (1)
- Prevention (1)
- Public Health (1)
- Quality Improvement (3)
- Quality of Care (1)
- Registries (2)
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- Transplantation (1)
- Urinary Tract Infection (UTI) (1)
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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 23 of 23 Research Studies DisplayedBranca 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
Toce MS, Michelson K, Hudgins J
Association of state-level opioid-reduction policies with pediatric opioid poisoning.
Opioid-reduction policies have been enacted by US states to address the opioid epidemic. Evidence of an association between policy implementation and decreased rates of pediatric opioid poisoning provides further justification for expanded implementation of these policies. The purpose of this study was to examine the association of 3 state-level opioid-reduction policies with the rate of opioid poisoning in children and adolescents.
AHRQ-funded; HS026503.
Citation: Toce MS, Michelson K, Hudgins J .
Association of state-level opioid-reduction policies with pediatric opioid poisoning.
JAMA Pediatr 2020 Oct;174(10):961-68. doi: 10.1001/jamapediatrics.2020.1980..
Keywords: Children/Adolescents, Opioids, Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Policy
Slatnick LR, Thornhill D, Deakyne Davies
Disseminated intravascular coagulation is an independent predictor of adverse outcomes in children in the emergency department with suspected sepsis.
The purpose of this study was to evaluate the impact of early disseminated intravascular coagulation (DIC) on illness severity in children using a database of emergency department ED encounters for children with suspected sepsis, in view of similar associations in adults. The investigators concluded that a DIC score of ≥3 was an independent predictor for both vasopressor use and mortality in this pediatric cohort, distinct from the adult overt DIC score cutoff of ≥5.
AHRQ-funded; HS025696.
Citation: Slatnick LR, Thornhill D, Deakyne Davies .
Disseminated intravascular coagulation is an independent predictor of adverse outcomes in children in the emergency department with suspected sepsis.
J Pediatr 2020 Oct;225:198-206.e2. doi: 10.1016/j.jpeds.2020.06.022..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Adverse Events, Mortality, Patient Safety, Outcomes
Emeriaud G, Napolitano N, Polikoff P
Impact of failure of noninvasive ventilation on the safety of pediatric tracheal intubation.
This prospective multicenter cohort study’s objective was to assess whether noninvasive ventilation failure in critically ill children was associated with severe tracheal intubation-associated events and severe oxygen desaturation during tracheal intubation. Data from the National Emergency Airway Registry for Children was used to examine data from thirteen PICUs (in 12 institutions) in the United States and Canada. The study included 956 tracheal intubation encounters, with 424 (44%) occurring after noninvasive ventilation failure with a median of 13 hours of noninvasive ventilation. The failure group included more infants (47% vs 33%) and patients with a respiratory diagnosis (56% vs 30%). Noninvasive ventilation failure was not associated with severe tracheal intubation-associated events without noninvasive ventilation but was associated with severe desaturation (15% vs 9%) without noninvasive ventilation.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Emeriaud G, Napolitano N, Polikoff P .
Impact of failure of noninvasive ventilation on the safety of pediatric tracheal intubation.
Crit Care Med 2020 Oct;48(10):1503-12. doi: 10.1097/ccm.0000000000004500..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Patient Safety, Adverse Events
Daigle CH, Fiadjoe JE, Laverriere EK
Difficult bag-mask ventilation in critically ill children is independently associated with adverse events.
This study looked at the epidemiology, risk factors, and clinical implications of difficult bag-mask ventilation among critically ill children. The prevalence and risk factors are described as well as its association with adverse tracheal intubation-associated events and oxygen desaturation in PICU patients. This retrospective review used observational data collected from a multicenter tracheal intubation database (National Emergency Airway Registry for Children) from January 2013 to December 2018 from 46 international PICUs. Difficult bag-mask ventilation was reported in 9.5% of 15,810 patients undergoing tracheal intubation with bag-mask ventilation. Difficult bag-mask ventilation was more commonly reported with increasing age, those with a primary respiratory diagnosis/indication for tracheal intubation, presence of difficulty airway features, more experienced provider level, and tracheal intubations without use of neuromuscular blockade. Specific intubation-associated or oxygen desaturation events occurred in 40.2% of patients with reported difficult bag-mask ventilation versus 19.8% in patients without difficult bag-mask ventilation.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Daigle CH, Fiadjoe JE, Laverriere EK .
Difficult bag-mask ventilation in critically ill children is independently associated with adverse events.
Crit Care Med 2020 Sep;48(9):e744-e52. doi: 10.1097/ccm.0000000000004425..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Risk
Ing C, Ma X, Sun M
Exposure to surgery and anesthesia in early childhood and subsequent use of attention deficit hyperactivity disorder medications.
This study examines the association between higher rates of attention deficit hyperactivity disorder (ADHD) diagnosis and exposure to surgery and anesthesia before the age of 5. Longitudinal pharmacy data for children enrolled in Texas and New York Medicaid from 1999 to 2010 were used. They examined the association between a single exposure to anesthesia before age 5 years for 1 of 4 common pediatric surgical procedures: pyloromytomy, inguinal hernia repair, circumcisions outside the perinatal period, and tonsillectomy and/or adenectomy; and persistent ADHD medication use. A total of 213,435 children were included in the study. Children with a single exposure to anesthesia were 37% more likely than unexposed children to persistently use ADHD medication.
AHRQ-funded; HS022941.
Citation: Ing C, Ma X, Sun M .
Exposure to surgery and anesthesia in early childhood and subsequent use of attention deficit hyperactivity disorder medications.
Anesth Analg 2020 Sep;131(3):723-33. doi: 10.1213/ane.0000000000004619..
Keywords: Children/Adolescents, Behavioral Health, Medication, Surgery, Adverse Drug Events (ADE), Adverse Events
Rinke ML, Oyeku SO, Heo M
Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): incidence, risk factors, and patient outcomes.
Catheter-associated urinary tract infections (CAUTIs) occur frequently in pediatric inpatients, and they are associated with increased morbidity and cost. Few studies have investigated ambulatory CAUTIs, despite at-risk children utilizing home urinary catheterization. This retrospective cohort and case-control study determined incidence, risk factors, and outcomes of pediatric patients with ambulatory CAUTI. The investigators concluded that pediatric ambulatory CAUTIs occurred in 18% of patients with catheters; they were associated with morbidity and healthcare utilization. Ambulatory indwelling catheter CAUTI incidence exceeded national inpatient incidence.
AHRQ-funded; HS024432.
Citation: Rinke ML, Oyeku SO, Heo M .
Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): incidence, risk factors, and patient outcomes.
Infect Control Hosp Epidemiol 2020 Aug;41(8):891-99. doi: 10.1017/ice.2020.204..
Keywords: Children/Adolescents, Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Risk, Ambulatory Care and Surgery, Adverse Events
Vyles D, Antoon JW, Norton A
Children with reported penicillin allergy: public health impact and safety of delabeling.
The objectives of this study were to: 1.) Review the relevant literature related to children with reported penicillin allergy 2.) Highlight the different ways in which children could be delabeled and 3.) Evaluate the public health impact that a penicillin allergy has for children. The investigators concluded that penicillin allergy was overdiagnosed, often incorrectly, and the label was frequently first applied during childhood.
AHRQ-funded; HS026395.
Citation: Vyles D, Antoon JW, Norton A .
Children with reported penicillin allergy: public health impact and safety of delabeling.
Ann Allergy Asthma Immunol 2020 Jun;124(6):558-65. doi: 10.1016/j.anai.2020.03.012..
Keywords: Children/Adolescents, Medication, Medication: Safety, Patient Safety, Adverse Drug Events (ADE), Adverse Events, Public Health
Dadlez NM, Adelman J, Bundy DG
Contributing factors for pediatric ambulatory diagnostic process errors: Project RedDE.
This study examined root causes of three common pediatric diagnostic errors by having 31 practices enrolled in a national QI collaborative perform monthly “mini-RCAs” (mini root cause analyses). The diagnoses errors studied were missed adolescent depression, missed elevated blood pressure, and missed actionable laboratory values. Twenty-eight practices submitted 184 mini-RCAs with the most common causes being patient volume (adolescent depression and elevated BP), inadequate staffing (adolescent depression), clinic milieu (elevated BP), written communication and provider knowledge (actionable laboratory values), and electronic health records (EHRs) – (elevated BP and actionable laboratory values). The median number of mini-RCAs submitted was 6.
AHRQ-funded; HS024538; HS024713; HS026121.
Citation: Dadlez NM, Adelman J, Bundy DG .
Contributing factors for pediatric ambulatory diagnostic process errors: Project RedDE.
Pediatr Qual Saf 2020 May-Jun;5(3):e299. doi: 10.1097/pq9.0000000000000299..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Quality Improvement, Quality of Care, Medical Errors, Adverse Events, Patient Safety
Cifra CL, Ten Eyck P, Dawson JD
Factors associated with diagnostic error on admission to a PICU: a pilot study.
This pilot retrospective cohort study examined errors in pediatric ICUs (PICUs) for children during the first 12 hours after PICU admission. A structured tool (Safer Dx) was used to identify diagnostic error in an academic tertiary institution. Out of 50 patients, 4 (8%) had diagnostic errors. The errors were in diagnoses of chronic ear infection, intracranial pressure (two cases), and Bartonella encephalitis. This pilot study will be expanded into a larger and more definitive multicenter study.
AHRQ-funded; HS022087.
Citation: Cifra CL, Ten Eyck P, Dawson JD .
Factors associated with diagnostic error on admission to a PICU: a pilot study.
Pediatr Crit Care Med 2020 May;21(5):e311-e15. doi: 10.1097/pcc.0000000000002257..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Critical Care, Intensive Care Unit (ICU), Hospitals
Pruitt LCC, Skarda DE, Rollins MD
Hirschsprung-associated enterocolitis in children treated at US children's hospitals.
The incidence of and risk factors for Hirschsprung's-associated enterocolitis (HAEC) following pull-through have been limited to single institutions studies. In this retrospective cohort study, the investigators characterized the incidence of, risk factors for, and consequences of post-operative HAEC. The investigators concluded that HAEC following pull-through occurs in a large proportion of infants with HD and predicts reoperation. They suggest that multicenter studies are needed to develop prediction models and treatment protocols for HAEC.
AHRQ-funded; HS025776.
Citation: Pruitt LCC, Skarda DE, Rollins MD .
Hirschsprung-associated enterocolitis in children treated at US children's hospitals.
J Pediatr Surg 2020 Mar;55(3):535-40. doi: 10.1016/j.jpedsurg.2019.10.060.
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Keywords: Children/Adolescents, Digestive Disease and Health, Surgery, Adverse Events, Risk, Hospitals
Lander DP, Durakovic N, Kallogjeri D
Incidence of infectious complications following cochlear implantation in children and adults.
The goal of this study was to determine the incidence and timing of infectious complications following cochlear implantation. Results showed low rates of infectious complications in cochlear implant recipients, and meningitis was exceedingly rare. Children aged 1 and 2 years experienced infectious complications more frequently than older children, with benefits of early implantation on language development outweighing the risk. Recommendations included increased vigilance by physicians when caring for young children early after implantation and children with prior implant infections.
AHRQ-funded; HS019455.
Citation: Lander DP, Durakovic N, Kallogjeri D .
Incidence of infectious complications following cochlear implantation in children and adults.
JAMA 2020 Jan 14;323(2):182-83. doi: 10.1001/jama.2019.18611..
Keywords: Children/Adolescents, Adverse Events, Surgery, Healthcare-Associated Infections (HAIs)
Woods-Hill CZ, Koontz DW, King AF
Practices, perceptions, and attitudes in the evaluation of critically ill children for bacteremia: a national survey.
Sending blood cultures in children at low risk of bacteremia can contribute to a cascade of unnecessary antibiotic exposure, adverse effects, and increased costs. In this study, the investigators aimed to describe practice variation, clinician beliefs, and attitudes about blood culture testing in critically ill children. They concluded that there is variation in blood culture practices in the pediatric ICU. Fear and reflexive habits are common drivers of cultures. These practices may contribute to over-testing for bacteremia.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Koontz DW, King AF .
Practices, perceptions, and attitudes in the evaluation of critically ill children for bacteremia: a national survey.
Pediatr Crit Care Med 2020 Jan;21(1):e23-e29. doi: 10.1097/pcc.0000000000002176..
Keywords: Children/Adolescents, Critical Care, Antimicrobial Stewardship, Antibiotics, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Intensive Care Unit (ICU), Decision Making
Feldman AG, Curtis DJ, Moore SL
Under-immunization of pediatric transplant recipients: a call to action for the pediatric community.
This article is a call to action for pediatric solid organ transplant recipients to receive their recommended immunizations. Vaccine-preventable infections (VIPs) occur in 1 in 6 pediatric transplant recipients and these hospitalizations result in significant morbidity, mortality, graft injury, and cost. There has been an increase in the overall population in non-medical vaccine exemptions, which reduces herd immunity and creates greater risk for patients undergoing or already having received transplants.
AHRQ-funded; HS026510.
Citation: Feldman AG, Curtis DJ, Moore SL .
Under-immunization of pediatric transplant recipients: a call to action for the pediatric community.
Pediatr Res 2020 Jan;87(2):277-81. doi: 10.1038/s41390-019-0507-4..
Keywords: Children/Adolescents, Transplantation, Vaccination, Adverse Events, Patient Safety
McNamara ER, Kurtz MP, Schaeffer AJ
30-day morbidity after augmentation enterocystoplasty and appendicovesicostomy: a NSQIP pediatric analysis.
The researchers report 30-day outcomes from the first nationally based, prospectively assembled cohort of pediatric patients undergoing these complex pediatric urologic procedures. There were a total of 110 National Surgical Quality Improvement Program (NSQIP) complications seen in 87 patients. The most common complication was urinary tract infection. The composite measure of any 30- day event was seen in 27.8 percent of the cohort.
AHRQ-funded; HS000063.
Citation: McNamara ER, Kurtz MP, Schaeffer AJ .
30-day morbidity after augmentation enterocystoplasty and appendicovesicostomy: a NSQIP pediatric analysis.
J Pediatr Urol 2015 Aug;11(4):209.e1-6. doi: 10.1016/j.jpurol.2015.04.016..
Keywords: Children/Adolescents, Outcomes, Surgery, Adverse Events, Quality Improvement
Kurtz MP, McNamara ER, Schaeffer AJ
Association of BMI and pediatric urologic postoperative events: results from pediatric NSQIP.
The researchers sought to determine the association of elevated BMI with overall 30-day postoperative events and wound complications in a large national sample of children undergoing urologic procedures. They concluded that BMI in the pediatric National Surgical Quality Improvement Program urologic population was found to be associated with overall complication after adjustment for case type and preoperative comorbidity.
AHRQ-funded; HS000063.
Citation: Kurtz MP, McNamara ER, Schaeffer AJ .
Association of BMI and pediatric urologic postoperative events: results from pediatric NSQIP.
J Pediatr Urol 2015 Aug;11(4):224.e1-6. doi: 10.1016/j.jpurol.2015.04.014..
Keywords: Surgery, Children/Adolescents, Obesity, Risk, Adverse Events
Leshem E, Tate JE, Steiner CA
AHRQ Author: Steiner CA
Acute gastroenteritis hospitalizations among US children following implementation of the rotavirus vaccine.
Because laboratory testing and coding for rotavirus are not routinely performed for patients with diarrhea, the researchers examined both all-cause acute gastroenteritis and rotavirus-coded hospitalizations among children younger than 5 years from 2000 through 2012. They found that, in 2012, when vaccine coverage was highest, the greatest reductions were observed for all-cause acute gastroenteritis (55 percent) and rotavirus-coded (94 percent) hospitalizations.
AHRQ-authored.
Citation: Leshem E, Tate JE, Steiner CA .
Acute gastroenteritis hospitalizations among US children following implementation of the rotavirus vaccine.
JAMA 2015 Jun 9;313(22):2282-4. doi: 10.1001/jama.2015.5571..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Vaccination, Children/Adolescents, Adverse Events
Stockwell DC, Bisarya H, Classen DC
A trigger tool to detect harm in pediatric inpatient settings.
The researchers developed and pilot tested a trigger tool that would identify the most common causes of harm in pediatric inpatient environments. After reviewing review 100 randomly selected inpatient records from each of 6 academic children’s hospitals, they found that the most common patient harms were intravenous catheter infiltrations/burns, respiratory distress, constipation, pain, and surgical complications.
AHRQ-funded; HS020513.
Citation: Stockwell DC, Bisarya H, Classen DC .
A trigger tool to detect harm in pediatric inpatient settings.
Pediatrics 2015 Jun;135(6):1036-42. doi: 10.1542/peds.2014-2152..
Keywords: Children/Adolescents, Patient Safety, Inpatient Care, Children/Adolescents, Adverse Events
Roxbury CR, Yang J, Salazar J
Safety and postoperative adverse events in pediatric otologic surgery: analysis of American College of Surgeons NSQIP-P 30-day outcomes.
This study described safety and postoperative sequelae of pediatric otologic surgery and identify predictive factors for postoperative events. It found that pediatric otologic procedures are common and have low rates of global 30-day postoperative events. Tympanomastoidectomy and cochlear implantation have the highest risk of 30-day readmission.
AHRQ-funded; HS022932.
Citation: Roxbury CR, Yang J, Salazar J .
Safety and postoperative adverse events in pediatric otologic surgery: analysis of American College of Surgeons NSQIP-P 30-day outcomes.
Otolaryngol Head Neck Surg 2015 May;152(5):790-5. doi: 10.1177/0194599815575711..
Keywords: Adverse Events, Children/Adolescents, Surgery, Patient Safety, Children/Adolescents, Quality Improvement
Tarquinio KM, Howell JD, Montgomery V
Current medication practice and tracheal intubation safety outcomes from a prospective multicenter observational cohort study.
The objective of this study was to evaluate the association of medication selection on specific tracheal intubation–associated events across pediatric intensive care units. It found that fentanyl, midazolam, and ketamine were the most commonly used induction agents, and the majority of tracheal intubations involved neuromuscular blockade. Ketamine use was not associated with lower prevalence of hypotension.
AHRQ-funded; HS022464; HS021583.
Citation: Tarquinio KM, Howell JD, Montgomery V .
Current medication practice and tracheal intubation safety outcomes from a prospective multicenter observational cohort study.
Pediatr Crit Care Med 2015 Mar;16(3):210-8. doi: 10.1097/pcc.0000000000000319..
Keywords: Children/Adolescents, Patient Safety, Intensive Care Unit (ICU), Adverse Events, Medication
Freedman JL, Faerber JI, Kang TI
Predictors of antiemetic alteration in pediatric acute myeloid leukemia.
The purpose of this study was to gain better knowledge of patient and cancer treatment factors associated with nausea/vomiting (NV) in order to enhance prophylaxis in children being treated for acute myeloid leukemia (AML). It found that treatment-related NV, as evidenced by antiemetic alterations, is more prevalent with increasing age.
AHRQ-funded; HS018425
Citation: Freedman JL, Faerber JI, Kang TI .
Predictors of antiemetic alteration in pediatric acute myeloid leukemia.
Pediatr Blood Cancer. 2014 Oct;61(10):1798-805. doi: 10.1002/pbc.25108..
Keywords: Adverse Drug Events (ADE), Adverse Events, Cancer, Children/Adolescents, Medication, Prevention
Nguyen C, Hernandez-Boussard T, Davies SM
Cleft palate surgery: an evaluation of length of stay, complications, and costs by hospital type.
The purpose of this study was to assess length of stay (LOS), complication rates, costs, and charges of cleft palate repair by various hospital types. Results showed that pediatric hospitals had higher comorbidities yet shorter LOS. Pediatric resources significantly decreased the relative rate of LOS greater than 2 days, and median costs and charges increased by 41% with LOS greater than 2 days.
AHRQ-funded; HS018558.
Citation: Nguyen C, Hernandez-Boussard T, Davies SM .
Cleft palate surgery: an evaluation of length of stay, complications, and costs by hospital type.
Cleft Palate Craniofac J 2014 Jul;51(4):412-9. doi: 10.1597/12-150.
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Keywords: Adverse Events, Children/Adolescents, Patient Safety, Children/Adolescents, Surgery
Nett S, Emeriaud G, Jarvis JD
Site-level variance for adverse tracheal intubation-associated events across 15 North American PICUs: a report from the national emergency airway registry for children*.
This observational study of 15 pediatric intensive care units (PICUs) found that substantial site-level variance exists in tracheal intubation practice, adverse tracheal intubation associated-events and severe tracheal intubation associated-events. After adjusting for patient and provider characteristics, neither PICU size nor presence of fellowship training program explained site-level variance.
AHRQ-funded; HS021583
Citation: Nett S, Emeriaud G, Jarvis JD .
Site-level variance for adverse tracheal intubation-associated events across 15 North American PICUs: a report from the national emergency airway registry for children*.
Pediatr Crit Care Med. 2014 May;15(4):306-13. doi: 10.1097/pcc.0000000000000120..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Registries, Adverse Events