title: Classification and team response to nonroutine events occurring during pediatric trauma resuscitation.
abstract: Errors directly causing serious harm are rare during pediatric trauma resuscitation, limiting the use of adverse outcome analysis for performance improvement in this setting. Errors not causing harm because of mitigation or chance may have similar causation and are more frequent than those causing adverse outcomes. Analyzing these error types is an alternative to adverse outcome analysis. The purpose of this study was to identify errors of any type during pediatric trauma resuscitation and evaluate team responses to their occurrence.
  
  
  
  Errors identified using video analysis were classified as errors of omission or commission and selection errors using input from trauma experts. The responses to error types and error frequency based on patient and event features were compared.
  
  
  
  Thirty-nine resuscitations were reviewed, identifying 337 errors (range, 2-26 per resuscitation). The most common errors were related to cervical spine stabilization (n = 93, 27.6%). Errors of omission (n = 135) and commission (n = 106) were more common than errors of selection (n = 96). Although 35.9% of all errors were acknowledged and compensation occurred after 43.6%, no response (acknowledgement or compensation) was observed after 51.3% of errors. Errors of omission and commission were more often acknowledged (40.7% and 39.6% vs. 25.0%, p = 0.03 and p = 0.04, respectively) and compensated for (50.4% and 47.2% vs. 29.2%, p = 0.004 and p = 0.01, respectively) than selection errors. Response differences between errors of omission and commission were not observed. The number of errors and the number of high-risk errors that occurred did not differ based on patient or event features.
  
  
  
  Errors are common during pediatric trauma resuscitation. Teams did not respond to most errors, although differences in team response were observed between error types. Determining causation of errors may be an approach for identifying latent safety threats contributing to adverse outcomes during pediatric trauma resuscitation.
  
  
  
  Therapeutic study, level III.
authors.affiliation: From the Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, District of Columbia (R.B.W., J.L.F., J.Y., R.S.B.); George Washington University School of Medicine, Washington, District of Columbia (G.F.Y.); Division of Emergency Medicine and Trauma Services, Children's Hospital of the King's Daughters, Norfolk, Virginia (P.C.M.); Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (F.G.Q.); Virginia Tech Carilion Research Institute, Roanoke, Virginia (S.H.P.); College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania (A.S.); and Department of Electrical and Computer Engineering, Rutgers University, Piscataway, New Jersey (I.M.).
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Webman
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Fritzeen
authors.forename: JaeWon
authors.initials: J
authors.lastname: Yang
authors.forename: Grace F
authors.initials: GF
authors.lastname: Ye
authors.forename: Paul C
authors.initials: PC
authors.lastname: Mullan
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Qureshi
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Parker
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Sarcevic
authors.forename: Ivan
authors.initials: I
authors.lastname: Marsic
authors.forename: Randall S
authors.initials: RS
authors.lastname: Burd
mesh_terms: D002648:Child; D005260:Female; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006801:Humans; D008297:Male; D008396:Maryland; D019300:Medical Errors / Q000145:classification*; D010348:Patient Care Team / Q000592:standards*; D010372:Pediatrics / Q000592:standards*; D012151:Resuscitation / Q000592:standards*; D014193:Trauma Centers / Q000458:organization & administration*; D014741:Video Recording