Critical incidents in paediatric critical care: who is at risk?
We evaluated the characteristics of children for whom critical incidents (CIs) were reported by performing prospective collection of patient data and retrospective review of reported CIs in a multidisciplinary neonatal-paediatric intensive care unit of a tertiary care university children's hospital. A period of 1 year was analysed (January to December 2007; 1,251 admissions). CIs comprised adverse events (actual patient injury), as well as near-misses. The report form of critical incidents was web-based and reporting was voluntary, anonymous and non-punitive. The severity of all CIs was divided into minor, moderate and major. Patients with and without CIs were compared regarding the following characteristics: Paediatric Index of Mortality (PIM2), duration of mechanical ventilation, length of stay in the intensive care, admission mode (surgery, cardiopulmonary bypass, cardiac/non-cardiac unit), age and sex. There were 360 CI reports (83 per 1,000 patient days; 13% major, 26% moderate, 61% minor severity). Of these, 310 CIs could be assigned to 198 specific patients. In the univariate analysis, patient-related risk factors for CIs were higher PIM2 score (p < 0.0001), increased length of stay (p < 0.0001), mechanical ventilation (p < 0.0001), increased ventilator days (p < 0.0001), male gender (p = 0.022) and young age (p < 0.0001). Using a logistic regression model, mechanical ventilation (p < 0.0001), male gender (p = 0.034) and length of stay (p < 0.0001) continued to be associated with the occurrence of CIs. Conclusion CIs often occur in paediatric intensive care. Among the patient-related factors, male gender, mechanical ventilation, and length of stay are independently associated with CIs. Already known at admission to intensive care are male gender and, usually, requirement for mechanical ventilation. Improved knowledge of the risk factors for CIs could help to minimize their frequency and thus improve quality of care.
Niesse
Oliver W
OW
Department of Intensive Care and Neonatology, University Children's Hospital, Zurich, Switzerland. oliver.niesse@kispi.uzh.ch
Sennhauser
Felix H
FH
Frey
Bernhard
B
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013557:Switzerland / Q000453:epidemiology
Crit Care Med. 2003 Jul;31(7):1901-7
12847381
Pediatrics. 2006 Oct;118(4):1332-40
17015521
Intensive Care Med. 2003 Feb;29(2):271-7
12541153
Pediatrics. 1986 Aug;78(2):238-44
3737300
Arch Dis Child Fetal Neonatal Ed. 2000 Nov;83(3):F182-5
11040165
Intensive Care Med. 2000 Jan;26(1):69-74
10663283
Pediatr Crit Care Med. 2006 Jan;7(1):2-6
16395066
J Clin Pharmacol. 2006 Apr;46(4):449-55
16554453
Paediatr Anaesth. 2006 Sep;16(9):968-73
16918660
Pediatrics. 2003 Mar;111(3):617-21
12612245
Crit Care Med. 2003 Apr;31(4):1006-11
12682464
Lancet. 2008 Feb 2;371(9610):404-10
18242414
Crit Care Med. 2004 Apr;32(4):1061-9
15071402
Arch Dis Child. 1986 Jun;61(6):559-64
2425752
Intensive Care Med. 2003 Feb;29(2):278-85
12541154
Crit Care Med. 1997 Aug;25(8):1289-97
9267940
Intensive Care Med. 1997 Feb;23(2):201-7
9069007
Lancet. 2004 Mar 20;363(9413):970-7
15043966
Crit Care Med. 2005 Aug;33(8):1694-700
16096443
Crit Care Med. 2009 Jan;37(1):334-5
19112289
JAMA. 1999 Feb 3;281(5):446-53
9952205
JAMA. 1999 Jul 21;282(3):267-70
10422996
Intensive Care Med. 2004 Jun;30(6):1041-6
15103459