title: Quality indicators for pediatric colonoscopy: results from a multicenter consortium.
abstract: OBJECTIVE
  Currently, there are no quality measures specific to children undergoing GI endoscopy. We aimed to determine the baseline quality of pediatric colonoscopy by using the Pediatric Endoscopy Database System-Clinical Outcomes Research Initiative (PEDS-CORI), a central registry.
  
  
  METHODS
  We conducted prospective data collection by using a standard computerized report generator and central registry (PEDS-CORI) to examine key quality indicators from 14 pediatric centers between January 2000 and December 2011. Specific quality indicators, including bowel preparation, ileal intubation rate, documentation of American Society of Anesthesiologists Physical Status Classification System (ASA) class, and procedure time, were compared during the study period.
  
  
  RESULTS
  We analyzed 21,807 colonoscopy procedures performed in patients with a mean age of 11.5 ± 4.8 years. Of the 21,807 reports received during the study period, 56% did not include bowel preparation quality, and 12.7% did not include ASA classification. When bowel preparation was reported, the quality was described as excellent, good, or fair in 90.3%. The overall ileal intubation rate was 69.4%, and 15.6% reported cecal intubation only, calculated to be 85% cecum or ileum intubation. Thus, 15% of colonoscopy procedures did not report reaching the cecum or ileum. When excluding the proportion of procedures not intended to reach the ileum (31.5%), the overall ileal intubation rate increased to 84.0%. The rate of ileum examination varied from 85% to 95%, depending on procedure indication.
  
  
  CONCLUSIONS
  Colonoscopy reports from our central registry revealed significant variations and inconsistent documentation in pediatric colonoscopy. Our study identifies areas for quality improvement and highlights the need for developing accepted quality measures specific to pediatric endoscopy.
authors.affiliation: The Section of Pediatric Gastroenterology, Hepatology and Nutrition at Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Kalpesh
authors.initials: K
authors.lastname: Thakkar
authors.affiliation: Department of Gastroenterology, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Holub
authors.affiliation: Department of Pediatrics, Baylor College of Medicine at Children's Hospital of San Antonio, San Antonio, Texas, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Gilger
authors.affiliation: The Section of Pediatric Gastroenterology and Nutrition at Phoenix Children's Hospital and the Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Shub
authors.affiliation: The Section of Pediatric Gastroenterology and Nutrition at Phoenix Children's Hospital and the Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: McOmber
authors.affiliation: The Section of Pediatric Gastroenterology at Children's Hospital of The King's Daughters, Norfolk, Virginia, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Tsou
authors.affiliation: The Section of Pediatric Gastroenterology, Hepatology and Nutrition at Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Fishman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003113:Colonoscopy / Q000592:standards*; D004282:Documentation / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal; D008297:Male; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D012042:Registries; D055815:Young Adult