title: Adverse events among children in Canadian hospitals: the Canadian Paediatric Adverse Events Study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. anne.matlow@wchospital.ca
authors: Anne G
authors: AG
authors: Matlow
authors: G Ross
authors: GR
authors: Baker
authors: Virginia
authors: V
authors: Flintoft
authors: Douglas
authors: D
authors: Cochrane
authors: Maitreya
authors: M
authors: Coffey
authors: Eyal
authors: E
authors: Cohen
authors: Catherine M G
authors: CM
authors: Cronin
authors: Rita
authors: R
authors: Damignani
authors: Robert
authors: R
authors: Dubé
authors: Roger
authors: R
authors: Galbraith
authors: Dawn
authors: D
authors: Hartfield
authors: Leigh Anne
authors: LA
authors: Newhook
authors: Cheri
authors: C
authors: Nijssen-Jordan
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000293:Adolescent; D000367:Age Factors; D002170:Canada; D002648:Child; D002675:Child, Preschool; D006761:Hospitals / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D019300:Medical Errors / Q000706:statistics & numerical data*; D012189:Retrospective Studies