Potentially Preventable Mortality in the Pediatric Intensive Care Unit: Findings from a Retrospective Mortality Analysis
Objective The goal of this study was to estimate the proportion and causes of potentially preventable mortality among critically ill children admitted to the pediatric intensive care unit (PICU). Methods The medical records of all patients who died in the PICU (age range: one month to 16 years) betw...
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| Veröffentlicht in: | Curēus (Palo Alto, CA) CA), 2020-03, Vol.12 (3), p.e7358-e7358 |
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| creator | Abbas, Qalab Memon, Fozia Laghari, Parveen Saleem, Ali Haque, Anwar |
| description | Objective The goal of this study was to estimate the proportion and causes of potentially preventable mortality among critically ill children admitted to the pediatric intensive care unit (PICU). Methods The medical records of all patients who died in the PICU (age range: one month to 16 years) between January 2014 and December 2015 were evaluated by two independent reviewers to determine whether there had been any delayed recognition of deteriorating conditions, delayed interventions, unintentional/unanticipated harm, medication errors, adverse reactions to transfusions, and hospital-acquired infections that could have resulted in unanticipated death. Preventability was labeled on a 6-point scale. Results During the study period, 92 of 690 patients did not survive [median age: 60 months, interquartile range (IQR): 114]. The median Pediatric Risk of Mortality (PRISM) III score was 17 (IQR: 6). Major diagnostic categories included sepsis (n = 29, 35%), central nervous system diseases (n = 16, 17%), oncological/hematological diseases (n = 6, 6%), cardiac diseases (n = 4, 4%), and miscellaneous conditions. None of the deaths had definitive or strong evidence of preventability. Four (4.3%) patients were in category 4 (i.e., possibly preventable, >50/50 chance), 15 (16.3%) in category 3 (possibly preventable, |
| doi_str_mv | 10.7759/cureus.7358 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7174862</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2396567534</sourcerecordid><originalsourceid>FETCH-LOGICAL-c339t-1bc218b34a745737cdbe6c22b0c667eca7ffa7b87d7e5c848e5cb040432fcb083</originalsourceid><addsrcrecordid>eNpdkdFrFDEQxoNYbKl98l0CvghyNZtkd3I-COVotVDxEPscstnZNiWXnEn28P775nq1Vl-SGfLLxzfzEfKmYacA7fyjnRJO-RREq16QI950aqYaJV8-qw_JSc53jLGGAWfAXpFDwQVXAtgR-b2MBUNxxvstXSbc1Mb0Hum3mIrxrmypC7TcIl3i4ExJztLLUL9kt0G6MAnpdXDlE71wYXDhJtMxxRU19AeWFPMabdmBf9XOgvHb7PJrcjAan_Hk8T4m1xfnPxdfZ1ffv1wuzq5mVoh5mTW95Y3qhTQgWxBghx47y3nPbNcBWgPjaKBXMAC2VklVz55JJgUfa6HEMfm8111P_QoHW-dLxut1ciuTtjoap_99Ce5W38SNhgak6ngVeP8okOKvCXPRK5ctem8CxilrLuZSqVbyrqLv_kPv4pTqwA9U13bQClmpD3vK1gXlhOOTmYbpXah6H6rehVrpt8_9P7F_IhT3RBKhYA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2396567534</pqid></control><display><type>article</type><title>Potentially Preventable Mortality in the Pediatric Intensive Care Unit: Findings from a Retrospective Mortality Analysis</title><source>PubMed Central Open Access</source><source>PubMed Central</source><creator>Abbas, Qalab ; Memon, Fozia ; Laghari, Parveen ; Saleem, Ali ; Haque, Anwar</creator><creatorcontrib>Abbas, Qalab ; Memon, Fozia ; Laghari, Parveen ; Saleem, Ali ; Haque, Anwar</creatorcontrib><description>Objective The goal of this study was to estimate the proportion and causes of potentially preventable mortality among critically ill children admitted to the pediatric intensive care unit (PICU). Methods The medical records of all patients who died in the PICU (age range: one month to 16 years) between January 2014 and December 2015 were evaluated by two independent reviewers to determine whether there had been any delayed recognition of deteriorating conditions, delayed interventions, unintentional/unanticipated harm, medication errors, adverse reactions to transfusions, and hospital-acquired infections that could have resulted in unanticipated death. Preventability was labeled on a 6-point scale. Results During the study period, 92 of 690 patients did not survive [median age: 60 months, interquartile range (IQR): 114]. The median Pediatric Risk of Mortality (PRISM) III score was 17 (IQR: 6). Major diagnostic categories included sepsis (n = 29, 35%), central nervous system diseases (n = 16, 17%), oncological/hematological diseases (n = 6, 6%), cardiac diseases (n = 4, 4%), and miscellaneous conditions. None of the deaths had definitive or strong evidence of preventability. Four (4.3%) patients were in category 4 (i.e., possibly preventable, >50/50 chance), 15 (16.3%) in category 3 (possibly preventable, <50/50 chance), 28 (30.4%) had some evidence of preventability, and 45 (49.0%) were labeled as definitely not preventable. Late identification (diagnostic error) of the worsening condition in four (21.0%) patients, slow intervention in six (31.6.0%), and hospital-acquired infections in 10 (52.6%) were found to be related to potentially preventable mortality. Conclusions Preventable diagnostic errors and nosocomial infections (NIs) are major contributors to preventable mortality. Structured mortality analysis provides actionable information for future preventive strategies. Improvement in care processes, including clinical decision support systems, could help reduce preventable mortality rates.</description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.7358</identifier><identifier>PMID: 32328370</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>Blood transfusions ; Cardiopulmonary resuscitation ; Clinical outcomes ; CPR ; Hospitals ; Intensive care ; Laboratories ; Medical errors ; Medical records ; Mortality ; Multiple organ dysfunction syndrome ; Nervous system ; Patient safety ; Pediatrics ; Preventive Medicine ; Quality Improvement ; Sepsis</subject><ispartof>Curēus (Palo Alto, CA), 2020-03, Vol.12 (3), p.e7358-e7358</ispartof><rights>Copyright © 2020, Abbas et al.</rights><rights>Copyright © 2020, Abbas et al. This work is published under http://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2020, Abbas et al. 2020 Abbas et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c339t-1bc218b34a745737cdbe6c22b0c667eca7ffa7b87d7e5c848e5cb040432fcb083</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174862/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174862/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32328370$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abbas, Qalab</creatorcontrib><creatorcontrib>Memon, Fozia</creatorcontrib><creatorcontrib>Laghari, Parveen</creatorcontrib><creatorcontrib>Saleem, Ali</creatorcontrib><creatorcontrib>Haque, Anwar</creatorcontrib><title>Potentially Preventable Mortality in the Pediatric Intensive Care Unit: Findings from a Retrospective Mortality Analysis</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><description>Objective The goal of this study was to estimate the proportion and causes of potentially preventable mortality among critically ill children admitted to the pediatric intensive care unit (PICU). Methods The medical records of all patients who died in the PICU (age range: one month to 16 years) between January 2014 and December 2015 were evaluated by two independent reviewers to determine whether there had been any delayed recognition of deteriorating conditions, delayed interventions, unintentional/unanticipated harm, medication errors, adverse reactions to transfusions, and hospital-acquired infections that could have resulted in unanticipated death. Preventability was labeled on a 6-point scale. Results During the study period, 92 of 690 patients did not survive [median age: 60 months, interquartile range (IQR): 114]. The median Pediatric Risk of Mortality (PRISM) III score was 17 (IQR: 6). Major diagnostic categories included sepsis (n = 29, 35%), central nervous system diseases (n = 16, 17%), oncological/hematological diseases (n = 6, 6%), cardiac diseases (n = 4, 4%), and miscellaneous conditions. None of the deaths had definitive or strong evidence of preventability. Four (4.3%) patients were in category 4 (i.e., possibly preventable, >50/50 chance), 15 (16.3%) in category 3 (possibly preventable, <50/50 chance), 28 (30.4%) had some evidence of preventability, and 45 (49.0%) were labeled as definitely not preventable. Late identification (diagnostic error) of the worsening condition in four (21.0%) patients, slow intervention in six (31.6.0%), and hospital-acquired infections in 10 (52.6%) were found to be related to potentially preventable mortality. Conclusions Preventable diagnostic errors and nosocomial infections (NIs) are major contributors to preventable mortality. Structured mortality analysis provides actionable information for future preventive strategies. Improvement in care processes, including clinical decision support systems, could help reduce preventable mortality rates.</description><subject>Blood transfusions</subject><subject>Cardiopulmonary resuscitation</subject><subject>Clinical outcomes</subject><subject>CPR</subject><subject>Hospitals</subject><subject>Intensive care</subject><subject>Laboratories</subject><subject>Medical errors</subject><subject>Medical records</subject><subject>Mortality</subject><subject>Multiple organ dysfunction syndrome</subject><subject>Nervous system</subject><subject>Patient safety</subject><subject>Pediatrics</subject><subject>Preventive Medicine</subject><subject>Quality Improvement</subject><subject>Sepsis</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkdFrFDEQxoNYbKl98l0CvghyNZtkd3I-COVotVDxEPscstnZNiWXnEn28P775nq1Vl-SGfLLxzfzEfKmYacA7fyjnRJO-RREq16QI950aqYaJV8-qw_JSc53jLGGAWfAXpFDwQVXAtgR-b2MBUNxxvstXSbc1Mb0Hum3mIrxrmypC7TcIl3i4ExJztLLUL9kt0G6MAnpdXDlE71wYXDhJtMxxRU19AeWFPMabdmBf9XOgvHb7PJrcjAan_Hk8T4m1xfnPxdfZ1ffv1wuzq5mVoh5mTW95Y3qhTQgWxBghx47y3nPbNcBWgPjaKBXMAC2VklVz55JJgUfa6HEMfm8111P_QoHW-dLxut1ciuTtjoap_99Ce5W38SNhgak6ngVeP8okOKvCXPRK5ctem8CxilrLuZSqVbyrqLv_kPv4pTqwA9U13bQClmpD3vK1gXlhOOTmYbpXah6H6rehVrpt8_9P7F_IhT3RBKhYA</recordid><startdate>20200321</startdate><enddate>20200321</enddate><creator>Abbas, Qalab</creator><creator>Memon, Fozia</creator><creator>Laghari, Parveen</creator><creator>Saleem, Ali</creator><creator>Haque, Anwar</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200321</creationdate><title>Potentially Preventable Mortality in the Pediatric Intensive Care Unit: Findings from a Retrospective Mortality Analysis</title><author>Abbas, Qalab ; Memon, Fozia ; Laghari, Parveen ; Saleem, Ali ; Haque, Anwar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c339t-1bc218b34a745737cdbe6c22b0c667eca7ffa7b87d7e5c848e5cb040432fcb083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Blood transfusions</topic><topic>Cardiopulmonary resuscitation</topic><topic>Clinical outcomes</topic><topic>CPR</topic><topic>Hospitals</topic><topic>Intensive care</topic><topic>Laboratories</topic><topic>Medical errors</topic><topic>Medical records</topic><topic>Mortality</topic><topic>Multiple organ dysfunction syndrome</topic><topic>Nervous system</topic><topic>Patient safety</topic><topic>Pediatrics</topic><topic>Preventive Medicine</topic><topic>Quality Improvement</topic><topic>Sepsis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abbas, Qalab</creatorcontrib><creatorcontrib>Memon, Fozia</creatorcontrib><creatorcontrib>Laghari, Parveen</creatorcontrib><creatorcontrib>Saleem, Ali</creatorcontrib><creatorcontrib>Haque, Anwar</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Curēus (Palo Alto, CA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abbas, Qalab</au><au>Memon, Fozia</au><au>Laghari, Parveen</au><au>Saleem, Ali</au><au>Haque, Anwar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Potentially Preventable Mortality in the Pediatric Intensive Care Unit: Findings from a Retrospective Mortality Analysis</atitle><jtitle>Curēus (Palo Alto, CA)</jtitle><addtitle>Cureus</addtitle><date>2020-03-21</date><risdate>2020</risdate><volume>12</volume><issue>3</issue><spage>e7358</spage><epage>e7358</epage><pages>e7358-e7358</pages><issn>2168-8184</issn><eissn>2168-8184</eissn><abstract>Objective The goal of this study was to estimate the proportion and causes of potentially preventable mortality among critically ill children admitted to the pediatric intensive care unit (PICU). Methods The medical records of all patients who died in the PICU (age range: one month to 16 years) between January 2014 and December 2015 were evaluated by two independent reviewers to determine whether there had been any delayed recognition of deteriorating conditions, delayed interventions, unintentional/unanticipated harm, medication errors, adverse reactions to transfusions, and hospital-acquired infections that could have resulted in unanticipated death. Preventability was labeled on a 6-point scale. Results During the study period, 92 of 690 patients did not survive [median age: 60 months, interquartile range (IQR): 114]. The median Pediatric Risk of Mortality (PRISM) III score was 17 (IQR: 6). Major diagnostic categories included sepsis (n = 29, 35%), central nervous system diseases (n = 16, 17%), oncological/hematological diseases (n = 6, 6%), cardiac diseases (n = 4, 4%), and miscellaneous conditions. None of the deaths had definitive or strong evidence of preventability. Four (4.3%) patients were in category 4 (i.e., possibly preventable, >50/50 chance), 15 (16.3%) in category 3 (possibly preventable, <50/50 chance), 28 (30.4%) had some evidence of preventability, and 45 (49.0%) were labeled as definitely not preventable. Late identification (diagnostic error) of the worsening condition in four (21.0%) patients, slow intervention in six (31.6.0%), and hospital-acquired infections in 10 (52.6%) were found to be related to potentially preventable mortality. Conclusions Preventable diagnostic errors and nosocomial infections (NIs) are major contributors to preventable mortality. Structured mortality analysis provides actionable information for future preventive strategies. Improvement in care processes, including clinical decision support systems, could help reduce preventable mortality rates.</abstract><cop>United States</cop><pub>Cureus Inc</pub><pmid>32328370</pmid><doi>10.7759/cureus.7358</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Blood transfusions Cardiopulmonary resuscitation Clinical outcomes CPR Hospitals Intensive care Laboratories Medical errors Medical records Mortality Multiple organ dysfunction syndrome Nervous system Patient safety Pediatrics Preventive Medicine Quality Improvement Sepsis |
| title | Potentially Preventable Mortality in the Pediatric Intensive Care Unit: Findings from a Retrospective Mortality Analysis |
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