title: Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe.
abstract: Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors.
  
  
  
  The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760.
  
  
  
  Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0-5·5) with an incidence of respiratory critical events of 3·1% (2·9-3·3). Cardiovascular instability occurred in 1·9% (1·7-2·1), with an immediate poor outcome in 5·4% (3·7-7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86-0·90; p<0·0001), medical history, and physical condition (1·60, 1·40-1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981-0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97-0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers.
  
  
  
  This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia.
  
  
  
  European Society of Anaesthesiology.
authors.affiliation: Department of Anaesthesia, Pharmacology and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland; University of Geneva, Geneva, Switzerland. Electronic address: walid.habre@hcuge.ch.
authors.forename: Walid
authors.initials: W
authors.lastname: Habre
authors.affiliation: Department of Anaesthesia, Istituto Giannina Gaslini, Genova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Disma
authors.affiliation: Bolyai Institute, University of Szeged, Szeged, Hungary.
authors.forename: Katalin
authors.initials: K
authors.lastname: Virag
authors.affiliation: Department of Anaesthesia and Intensive Care, Cnopf'sche Kinderklinik/Klinik Hallerwiese, Nürnberg, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Becke
authors.affiliation: Department of Anaesthesia and Intensive Care, Odense University Hospital, Odense, Denmark; Department of Clinical Research, The University of Southern Denmark, Odense, Denmark.
authors.forename: Tom G
authors.initials: TG
authors.lastname: Hansen
authors.affiliation: Department of Anaesthesia, Luzerner Kantonsspital, Luzern, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Jöhr
authors.affiliation: Research Department, European Society of Anaesthesiology, Brussels, Belgium.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Leva
authors.affiliation: Department of Anaesthesia, Royal Hospital For Children, Glasgow, UK; University of Glasgow, Glasgow, UK.
authors.forename: Neil S
authors.initials: NS
authors.lastname: Morton
authors.affiliation: Department of Anaesthesiology, Maastricht University Medical Centre, Maastricht, Netherlands.
authors.forename: Petronella M
authors.initials: PM
authors.lastname: Vermeulen
authors.affiliation: Department of Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Marzena
authors.initials: M
authors.lastname: Zielinska
authors.affiliation: Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.
authors.forename: Krisztina
authors.initials: K
authors.lastname: Boda
authors.affiliation: Département d'Anesthésie-Réanimation pédiatrique, Hôpital Jeanne de Flandre, CHRU de Lille, Lille, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Veyckemans
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000768:Anesthesia, General / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D004342:Drug Hypersensitivity / Q000453:epidemiology* / Q000209:etiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000453:epidemiology* / Q000209:etiology