Unexplained Deaths in a Children's Hospital: An Epidemiologic Assessment
During a nine-month period, July 1980 through March 1981, the mortality rate for patients on the cardiology ward of a children's hospital was 43.1 deaths per 10,000 patient-days, as compared with 11.0 deaths per 10,000 patient-days during the preceding 54 months. Twenty-five (76 per cent) of 33...
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| Veröffentlicht in: | The New England journal of medicine 1985-07, Vol.313 (4), p.211-216 |
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| creator | Buehler, James W Smith, Lesbia F Wallace, Evelyn M Heath, Clark W Kusiak, Robert Herndon, Joy L |
| description | During a nine-month period, July 1980 through March 1981, the mortality rate for patients on the cardiology ward of a children's hospital was 43.1 deaths per 10,000 patient-days, as compared with 11.0 deaths per 10,000 patient-days during the preceding 54 months. Twenty-five (76 per cent) of 33 infant deaths during this nine-month period occurred between midnight and 6:00 a.m., as compared with 1 of 10 infant deaths during a separate 27-month period (P |
| doi_str_mv | 10.1056/NEJM198507253130402 |
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ON March 25, 1981, a nurse employed on the cardiology service of a children's hospital in Toronto, Canada, was arrested and accused of administering overdoses of digoxin to four patients who had died during the preceding three months. Unusually high levels of digoxin had been detected in specimens collected before or after death from all four. After the third death, digoxin was declared a controlled substance at the hospital, and ward supplies of the drug were removed and restocked in locked cabinets. Approximately five to six hours later, the fourth child underwent cardiac arrest. Although digoxin had never been prescribed . . .</description><identifier>ISSN: 0028-4793</identifier><identifier>EISSN: 1533-4406</identifier><identifier>DOI: 10.1056/NEJM198507253130402</identifier><identifier>PMID: 4010725</identifier><identifier>CODEN: NEJMAG</identifier><language>eng</language><publisher>Boston, MA: Massachusetts Medical Society</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiology ; Children ; Children & youth ; Clinical death. Palliative care. Organ gift and preservation ; Confidence intervals ; Coronary artery disease ; Criminal investigations ; Digoxin ; Digoxin - poisoning ; Disease control ; Drug dosages ; Drug overdose ; Epidemics ; Epidemiologic Methods ; Epidemiology ; Forensic Medicine ; Forensic science ; Heart diseases ; Heart Diseases - mortality ; Hospital Bed Capacity, 500 and over ; Hospital Units - standards ; Hospitals ; Hospitals, Pediatric - standards ; Hospitals, Special - standards ; Humans ; Infant ; Infant, Newborn ; Intensive care ; Intensive Care Units, Neonatal - standards ; Intravenous administration ; Medical errors ; Medical sciences ; Medication Errors ; Mortality ; Nurses ; Nursing ; Ontario ; Overdose ; Pediatrics ; Peer Review ; Personnel Staffing and Scheduling ; Risk ; Space-Time Clustering ; Teams ; Time ; Toxicity</subject><ispartof>The New England journal of medicine, 1985-07, Vol.313 (4), p.211-216</ispartof><rights>1985 INIST-CNRS</rights><rights>Copyright Massachusetts Medical Society Jul 25, 1985</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c380t-5ab337a6289790265a0b12e8195aa60b39c563a600c468ceb1d513836e38ae7c2</cites></display><links><openurl>$$Topenurl_article</openurl><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>776</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=9212941$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/4010725$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Buehler, James W</creatorcontrib><creatorcontrib>Smith, Lesbia F</creatorcontrib><creatorcontrib>Wallace, Evelyn M</creatorcontrib><creatorcontrib>Heath, Clark W</creatorcontrib><creatorcontrib>Kusiak, Robert</creatorcontrib><creatorcontrib>Herndon, Joy L</creatorcontrib><title>Unexplained Deaths in a Children's Hospital: An Epidemiologic Assessment</title><title>The New England journal of medicine</title><addtitle>N Engl J Med</addtitle><description>During a nine-month period, July 1980 through March 1981, the mortality rate for patients on the cardiology ward of a children's hospital was 43.1 deaths per 10,000 patient-days, as compared with 11.0 deaths per 10,000 patient-days during the preceding 54 months. Twenty-five (76 per cent) of 33 infant deaths during this nine-month period occurred between midnight and 6:00 a.m., as compared with 1 of 10 infant deaths during a separate 27-month period (P<0.001). Although nearly all deaths occurred in patients with serious congenital heart disease, epidemic-period deaths were more likely to have an unexpected timing and a clinical pattern consistent with digoxin toxicity. In four patients, forensic and clinical digoxin measurements suggested that an intravenous overdose of digoxin had been administered shortly before death. Although a review of nursing schedules revealed a strong association (relative risk, 64.6) between infant deaths and the duty times of a particular nurse, the cause of the epidemic remains unclear. The study led to suggestions that the hospital strengthen central control over procedures for dispensing medicines and implement a system for monitoring the occurrence of deaths by time and place within the hospital. (N Engl J Med 1985; 313: 211–6.)
ON March 25, 1981, a nurse employed on the cardiology service of a children's hospital in Toronto, Canada, was arrested and accused of administering overdoses of digoxin to four patients who had died during the preceding three months. Unusually high levels of digoxin had been detected in specimens collected before or after death from all four. After the third death, digoxin was declared a controlled substance at the hospital, and ward supplies of the drug were removed and restocked in locked cabinets. Approximately five to six hours later, the fourth child underwent cardiac arrest. Although digoxin had never been prescribed . . .</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Children</subject><subject>Children & youth</subject><subject>Clinical death. Palliative care. Organ gift and preservation</subject><subject>Confidence intervals</subject><subject>Coronary artery disease</subject><subject>Criminal investigations</subject><subject>Digoxin</subject><subject>Digoxin - poisoning</subject><subject>Disease control</subject><subject>Drug dosages</subject><subject>Drug overdose</subject><subject>Epidemics</subject><subject>Epidemiologic Methods</subject><subject>Epidemiology</subject><subject>Forensic Medicine</subject><subject>Forensic science</subject><subject>Heart diseases</subject><subject>Heart Diseases - mortality</subject><subject>Hospital Bed Capacity, 500 and over</subject><subject>Hospital Units - standards</subject><subject>Hospitals</subject><subject>Hospitals, Pediatric - standards</subject><subject>Hospitals, Special - standards</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Intensive care</subject><subject>Intensive Care Units, Neonatal - standards</subject><subject>Intravenous administration</subject><subject>Medical errors</subject><subject>Medical sciences</subject><subject>Medication Errors</subject><subject>Mortality</subject><subject>Nurses</subject><subject>Nursing</subject><subject>Ontario</subject><subject>Overdose</subject><subject>Pediatrics</subject><subject>Peer Review</subject><subject>Personnel Staffing and Scheduling</subject><subject>Risk</subject><subject>Space-Time Clustering</subject><subject>Teams</subject><subject>Time</subject><subject>Toxicity</subject><issn>0028-4793</issn><issn>1533-4406</issn><fulltext>false</fulltext><rsrctype>article</rsrctype><creationdate>1985</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kE9Lw0AQxRdRaq1-AhECCh5KdGb_ZfcotVql6sWew2azpSlJGndT0G9vSkNP4lxm4P3ePHiEXCLcIQh5_z59fUOtBCRUMGTAgR6RIQrGYs5BHpMhAFUxTzQ7JWchrKEb5HpABhxw5xqS8aJ2301pitrl0aMz7SpERR2ZaLIqyty7-jZEs01oitaU5-RkacrgLvo9Ioun6edkFs8_nl8mD_PYMgVtLEzGWGIkVTrRQKUwkCF1CrUwRkLGtBWSdRdYLpV1GeYCmWLSMWVcYumIXO__Nn7ztXWhTdebra-7yBRVolAJxpOOYnvK-k0I3i3TxheV8T8pQrrrJ_2jn8511f_eZpXLD56-kE6_6XUTrCmX3tS2CAdMU6SaY4eN91hVhbR26-rf0F8eFHVb</recordid><startdate>19850725</startdate><enddate>19850725</enddate><creator>Buehler, James W</creator><creator>Smith, Lesbia F</creator><creator>Wallace, Evelyn M</creator><creator>Heath, Clark W</creator><creator>Kusiak, Robert</creator><creator>Herndon, Joy L</creator><general>Massachusetts Medical Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TZ</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K0Y</scope><scope>LK8</scope><scope>M0R</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope></search><sort><creationdate>19850725</creationdate><title>Unexplained Deaths in a Children's Hospital</title><author>Buehler, James W ; Smith, Lesbia F ; Wallace, Evelyn M ; Heath, Clark W ; Kusiak, Robert ; Herndon, Joy L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c380t-5ab337a6289790265a0b12e8195aa60b39c563a600c468ceb1d513836e38ae7c2</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1985</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiology</topic><topic>Children</topic><topic>Children & youth</topic><topic>Clinical death. Palliative care. Organ gift and preservation</topic><topic>Confidence intervals</topic><topic>Coronary artery disease</topic><topic>Criminal investigations</topic><topic>Digoxin</topic><topic>Digoxin - poisoning</topic><topic>Disease control</topic><topic>Drug dosages</topic><topic>Drug overdose</topic><topic>Epidemics</topic><topic>Epidemiologic Methods</topic><topic>Epidemiology</topic><topic>Forensic Medicine</topic><topic>Forensic science</topic><topic>Heart diseases</topic><topic>Heart Diseases - mortality</topic><topic>Hospital Bed Capacity, 500 and over</topic><topic>Hospital Units - standards</topic><topic>Hospitals</topic><topic>Hospitals, Pediatric - standards</topic><topic>Hospitals, Special - standards</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Intensive care</topic><topic>Intensive Care Units, Neonatal - standards</topic><topic>Intravenous administration</topic><topic>Medical errors</topic><topic>Medical sciences</topic><topic>Medication 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China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><jtitle>The New England journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>no_fulltext</fulltext></delivery><addata><au>Buehler, James W</au><au>Smith, Lesbia F</au><au>Wallace, Evelyn M</au><au>Heath, Clark W</au><au>Kusiak, Robert</au><au>Herndon, Joy L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Unexplained Deaths in a Children's Hospital: An Epidemiologic Assessment</atitle><jtitle>The New England journal of medicine</jtitle><addtitle>N Engl J Med</addtitle><date>1985-07-25</date><risdate>1985</risdate><volume>313</volume><issue>4</issue><spage>211</spage><epage>216</epage><pages>211-216</pages><issn>0028-4793</issn><eissn>1533-4406</eissn><coden>NEJMAG</coden><abstract>During a nine-month period, July 1980 through March 1981, the mortality rate for patients on the cardiology ward of a children's hospital was 43.1 deaths per 10,000 patient-days, as compared with 11.0 deaths per 10,000 patient-days during the preceding 54 months. Twenty-five (76 per cent) of 33 infant deaths during this nine-month period occurred between midnight and 6:00 a.m., as compared with 1 of 10 infant deaths during a separate 27-month period (P<0.001). Although nearly all deaths occurred in patients with serious congenital heart disease, epidemic-period deaths were more likely to have an unexpected timing and a clinical pattern consistent with digoxin toxicity. In four patients, forensic and clinical digoxin measurements suggested that an intravenous overdose of digoxin had been administered shortly before death. Although a review of nursing schedules revealed a strong association (relative risk, 64.6) between infant deaths and the duty times of a particular nurse, the cause of the epidemic remains unclear. The study led to suggestions that the hospital strengthen central control over procedures for dispensing medicines and implement a system for monitoring the occurrence of deaths by time and place within the hospital. (N Engl J Med 1985; 313: 211–6.)
ON March 25, 1981, a nurse employed on the cardiology service of a children's hospital in Toronto, Canada, was arrested and accused of administering overdoses of digoxin to four patients who had died during the preceding three months. Unusually high levels of digoxin had been detected in specimens collected before or after death from all four. After the third death, digoxin was declared a controlled substance at the hospital, and ward supplies of the drug were removed and restocked in locked cabinets. Approximately five to six hours later, the fourth child underwent cardiac arrest. Although digoxin had never been prescribed . . .</abstract><cop>Boston, MA</cop><pub>Massachusetts Medical Society</pub><pmid>4010725</pmid><doi>10.1056/NEJM198507253130402</doi><tpages>6</tpages></addata></record> |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cardiology Children Children & youth Clinical death. Palliative care. Organ gift and preservation Confidence intervals Coronary artery disease Criminal investigations Digoxin Digoxin - poisoning Disease control Drug dosages Drug overdose Epidemics Epidemiologic Methods Epidemiology Forensic Medicine Forensic science Heart diseases Heart Diseases - mortality Hospital Bed Capacity, 500 and over Hospital Units - standards Hospitals Hospitals, Pediatric - standards Hospitals, Special - standards Humans Infant Infant, Newborn Intensive care Intensive Care Units, Neonatal - standards Intravenous administration Medical errors Medical sciences Medication Errors Mortality Nurses Nursing Ontario Overdose Pediatrics Peer Review Personnel Staffing and Scheduling Risk Space-Time Clustering Teams Time Toxicity |
| title | Unexplained Deaths in a Children's Hospital: An Epidemiologic Assessment |
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