More than 4,000 hospitalized children died of injuries caused by medical errors in 2000, concludes an analysis of 5.7 million discharge records from hospitals in 27 states. Developmental changes, epidemiology, and demographic characteristics all have specific effects on hospitalized children's risks of medical injury, and these risks differ from those of hospitalized adults.
Using "patient safety indicators" (PSIs), the study authors mined pediatric hospital discharge records for relevant data. PSIs are markers of medical error that can be extracted from a hospital's administrative data; they were developed by the Agency for Healthcare Research Quality (AHRQ) as a means of studying all hospitalized patients. (Go to http://www.qualityindicators.ahrq.gov for a complete listing of PSIs). They found high rates of accidental injury among hospitalized children and determined that the youngest and poorest children seem to suffer most.
At particularly high risk for injury from medical error were adolescent mothers and their babies. Obstetric trauma-which accounted for three of the six most common sources of medical injury to patients under 18 years of age-occurred less often in hospitals that had higher levels of nursing expertise. Three types of injury tended to disproportionately affect infants younger than one month of age (in one case for obvious reasons): birth trauma injury to a neonate, failure to rescue, and postoperative sepsis.
Children who had Medicaid as their primary insurer were more likely to suffer from postoperative sepsis, postoperative respiratory failure, or infection. The authors note that these injuries also carry substantial costs, some adding more than $100,000 to the cost of a hospital stay. In addition to making a "business case for patient safety," the authors call for studies of near-miss events, so that hospitals can prevent problems, rather than waiting to count injuries and measure excess mortality after harm has occurred.-Fran Mennick, BSN, RN
Miller MR, Zhan C. Pediatrics 2004;113(6): 1741-46.