title: Anesthesia-related critical incidents in the perioperative period in children; a proposal for an anesthesia-related reporting system for critical incidents in children.
abstract: BACKGROUND
  The incidence, type and severity of anesthesia-related critical incidents during the perioperative phase has been investigated less in children than in adults.
  
  
  OBJECTIVE
  The aim of the study was to identify and analyze anesthesia-related critical incidents in children to identify areas to improve current clinical practice, and to propose a specialized anesthesia-related critical incidence registration for children.
  
  
  METHODS
  All reported pediatric anesthesia-related critical incidents reported on a voluntary reporting based on a 20-item complication list of the Dutch Society of Anesthesiology between January 2007 and August 2013 were analyzed. An anesthesia-related critical incident was defined as 'any incident that affected, or could have affected, the safety of the patient while under the care of an anesthetist'. As the 20-item complications list was too crude for detailed analyses, all critical incidents were reclassified into the more detailed German classification lists with the adjustment of specific items for children (in total 10 categories with 101 different subcategories).
  
  
  RESULTS
  During the 6-year period, a total of 1214 critical incidents were reported out of 35 190 anesthetics (cardiac and noncardiac anesthesia cases). The most frequently reported incidents (46.5%) were related to the respiratory system. Infants <1 year, children with ASA physical status III and IV, and emergency procedures had a higher rate of adverse incidents.
  
  
  CONCLUSIONS
  Respiratory events were the most reported commonly critical incidents in children. Both the Dutch and German existing lists of critical incident definitions appeared not to be sufficient for accurate classification in children. The present list can be used for a new registration system for critical incidents in pediatric anesthesia.
authors: Department of Anesthesia, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Jurgen C
authors: JC
authors: de Graaff
authors: Marie-Christine
authors: MC
authors: Sarfo
authors: Leo
authors: L
authors: van Wolfswinkel
authors: Désirée B M
authors: DB
authors: van der Werff
authors: Antonius N J
authors: AN
authors: Schouten
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands; D059035:Perioperative Period / Q000706:statistics & numerical data*; D012308:Risk Management / Q000379:methods* / Q000706:statistics & numerical data*; D012720:Severity of Illness Index
keywords: anesthesia; complications; critical incidents; pediatric; perioperative