Dataset Information

Adverse events among children in Canadian hospitals: the Canadian Paediatric Adverse Events Study.

ABSTRACT:

Background

Limited data are available on adverse events among children admitted to hospital. The Canadian Paediatric Adverse Events Study was done to describe the epidemiology of adverse events among children in hospital in Canada.

Methods

We performed a 2-stage medical record review at 8 academic pediatric centres and 14 community hospitals in Canada. We reviewed charts from patients admitted from April 2008 through March 2009, evenly distributed across 4 age groups (0 to 28 d; 29 to 365 d; > 1 to 5 yr and > 5 to 18 yr). In stage 1, nurses and health records personnel who had received training in the use of the Canadian Paediatric Trigger Tool reviewed medical records to detect triggers for possible adverse events. In stage 2, physicians reviewed the charts identified as having triggers and described the adverse events.

Results

A total of 3669 children were admitted to hospital during the study period. The weighted rate of adverse events was 9.2%. Adverse events were more frequent in academic pediatric centres than in community hospitals (adjusted odds ratio [OR] 2.98, 95% confidence interval [CI] 1.65-5.39). The incidence of preventable adverse events was not significantly different between types of hospital, but nonpreventable adverse events were more common in academic pediatric centres (adjusted OR 4.39, 95% CI 2.08-9.27). Surgical events predominated overall and occurred more frequently in academic pediatric centres than in community hospitals (37.2% v. 21.5%, relative risk [RR] 1.7, 95% CI 1.0-3.1), whereas events associated with diagnostic errors were significantly less frequent (11.1% v. 23.1%, RR 0.5, 95% CI 0.2-0.9).

Interpretation

More children have adverse events in academic pediatric centres than in community hospitals; however, adverse events in the former are less likely to be preventable. There are many opportunities to reduce harm affecting children in hospital in Canada, particularly related to surgery, intensive care and diagnostic error.

SUBMITTER: Matlow AG

PROVIDER: S-EPMC3447037 | biostudies-literature | 2012 Sep

REPOSITORIES: biostudies-literature

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Publications

Adverse events among children in Canadian hospitals: the Canadian Paediatric Adverse Events Study.

Matlow Anne G AG Baker G Ross GR Flintoft Virginia V Cochrane Douglas D Coffey Maitreya M Cohen Eyal E Cronin Catherine M G CM Damignani Rita R Dubé Robert R Galbraith Roger R Hartfield Dawn D Newhook Leigh Anne LA Nijssen-Jordan Cheri C

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 20120730 13

<h4>Background</h4>Limited data are available on adverse events among children admitted to hospital. The Canadian Paediatric Adverse Events Study was done to describe the epidemiology of adverse events among children in hospital in Canada.<h4>Methods</h4>We performed a 2-stage medical record review at 8 academic pediatric centres and 14 community hospitals in Canada. We reviewed charts from patients admitted from April 2008 through March 2009, evenly distributed across 4 age groups (0 to 28 d; 2 ...[more]

PMID: 22847964

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Project description:BACKGROUND:Nevirapine is the only nonnucleoside reverse transcriptase inhibitor currently available as a paediatric fixed-dose-combination tablet and is widely used in African children. Nonetheless, the number of investigations into pharmacokinetic determinants of virological suppression in African children is limited, and the predictive power of the current therapeutic range was never evaluated in this population, thereby limiting treatment optimization. METHODS:We analysed data from 322 African children (aged 0.3-13 years) treated with nevirapine, lamivudine, and either abacavir, stavudine, or zidovudine, and followed up to 144 weeks. Nevirapine trough concentration (Cmin) and other factors were tested for associations with viral load more than 100 copies/ml and transaminase increases more than grade 1 using proportional hazard and logistic models in 219 initially antiretroviral treatment (ART)-naive children. RESULTS:Pre-ART viral load, adherence, and nevirapine Cmin were associated with viral load nonsuppression [hazard ratio?=?2.08 (95% confidence interval (CI): 1.50-2.90, P?<?0.001) for 10-fold higher pre-ART viral load, hazard ratio?=?0.78 (95% CI: 0.68-0.90, P?<?0.001) for 10% improvement in adherence, and hazard ratio?=?0.94 (95% CI: 0.90-0.99, P?=?0.014) for a 1?mg/l increase in nevirapine Cmin]. There were additional effects of pre-ART CD4 cell percentage and clinical site. The risk of virological nonsuppression decreased with increasing nevirapine Cmin, and there was no clear Cmin threshold predictive of virological nonsuppression. Transient transaminase elevations more than grade 1 were associated with high Cmin (>12.4?mg/l), hazard ratio?=?5.18 (95% CI 1.95-13.80, P?<?0.001). CONCLUSION:Treatment initiation at lower pre-ART viral load and higher pre-ART CD4 cell percentage, increased adherence, and maintaining average Cmin higher than current target could improve virological suppression of African children treated with nevirapine without increasing toxicity.

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Dataset Information

Adverse events among children in Canadian hospitals: the Canadian Paediatric Adverse Events Study.

Background

Methods

Results

Interpretation

Publications

Adverse events among children in Canadian hospitals: the Canadian Paediatric Adverse Events Study.

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