Limited data are available on adverse events among children admitted to hospital. The Canadian Paediatric Adverse Events Study was done to describe the epidemiology of adverse events among children in hospital in Canada.
We performed a 2-stage medical record review at 8 academic pediatric centres and 14 community hospitals in Canada. We reviewed charts from patients admitted from April 2008 through March 2009, evenly distributed across 4 age groups (0 to 28 d; 29 to 365 d; > 1 to 5 yr and > 5 to 18 yr). In stage 1, nurses and health records personnel who had received training in the use of the Canadian Paediatric Trigger Tool reviewed medical records to detect triggers for possible adverse events. In stage 2, physicians reviewed the charts identified as having triggers and described the adverse events.
A total of 3669 children were admitted to hospital during the study period. The weighted rate of adverse events was 9.2%. Adverse events were more frequent in academic pediatric centres than in community hospitals (adjusted odds ratio [OR] 2.98, 95% confidence interval [CI] 1.65-5.39). The incidence of preventable adverse events was not significantly different between types of hospital, but nonpreventable adverse events were more common in academic pediatric centres (adjusted OR 4.39, 95% CI 2.08-9.27). Surgical events predominated overall and occurred more frequently in academic pediatric centres than in community hospitals (37.2% v. 21.5%, relative risk [RR] 1.7, 95% CI 1.0-3.1), whereas events associated with diagnostic errors were significantly less frequent (11.1% v. 23.1%, RR 0.5, 95% CI 0.2-0.9).
More children have adverse events in academic pediatric centres than in community hospitals; however, adverse events in the former are less likely to be preventable. There are many opportunities to reduce harm affecting children in hospital in Canada, particularly related to surgery, intensive care and diagnostic error.
Anne G. Matlow,G. Ross Baker,Virginia Flintoft,Douglas Cochrane,Maitreya Coffey,Eyal Cohen,Catherine M.G. Cronin,Rita Damignani,Robert Dubé,Roger Galbraith,Dawn Hartfield,Leigh Anne Newhook,Cheri Nijssen-Jordan From the Department of Pediatrics (Matlow, Coffey, Cohen), Hospital for Sick Children; the Department of Pediatrics (Matlow, Coffey, Cohen), University of Toronto; University of Toronto Centre for Patient Safety (Matlow, Baker, Flintoft, Coffey, Cohen); Institute of Health Policy, Management and Evaluation (Baker, Flintoft), University of Toronto, Toronto, Ont.; the Department of Surgery (Cochrane), University of British Columbia; BC Patient Safety and Quality Council (Cochrane), Vancouver, BC; Child Health Program (Cronin), Winnipeg Regional Health Authority, Winnipeg, Man.; the Department of Quality and Risk Management (Damignani), Hospital for Sick Children, Toronto, Ont.; the Department of Paediatrics (Dubé), Centre Hospitalier Universitaire Ste-Justine, University of Montreal, Montréal, Que.; the Department of Pediatrics (Galbraith, Nijssen-Jordan), Faculty of Medicine, University of Calgary, Calgary, Alta; the Department of Pediatrics (Hartfield), University of Alberta, Edmonton, Alta.; the Discipline of Pediatrics (Newhook), Memorial University; and Janeway Child Healthcare Centre (Newhook), Eastern Health, St. John’s, NL
Canadian Medical Association Journal