Virginia Commonwealth University School of Medicine, Inova Campus, Pediatric Critical Care, Inova Fairfax Hospital for Children, Falls Church, VA, USA.
Pediatr Crit Care Med. 2010 Sep;11(5):568-78. doi: 10.1097/PCC.0b013e3181d8e405.
Selection of relevant patient safety interventions for the pediatric intensive care (PICU) requires identification of the types and severity of adverse events (AEs) and adverse drug events (ADEs) that occur in this setting. The study's objectives were to: 1) determine the rates of AEs/ADEs, including types, severity, and preventability, in PICU patients; 2) identify population characteristics associated with increased risk of AEs/ADEs; 3) develop and test a PICU specific trigger tool to facilitate identification of AEs/ADEs.
DESIGN, SETTING, PATIENTS: Retrospective, cross-sectional, randomized review of 734 patient records who were discharged from 15 U.S. PICUs between September and December 2005.
A novel PICU-focused trigger tool for AE/ADE detection.
Sixty-two percent of PICU patients had at least one AE. A total of 1488 AEs, including 256 ADEs, were identified. This translates to a rate of 28.6 AEs and 4.9 ADEs per 100 patient-days. The most common types of AEs were catheter complications, uncontrolled pain, and endotracheal tube malposition. Ten percent of AEs were classified as life-threatening or permanent; 45% were deemed preventable. Higher adjusted rates of AEs were found in surgical patients (p = .02), patients intubated at some point during their PICU stay (p = .002), and patients who died (p < .001). Surgical patients had higher preventable adjusted AE (p = .01) and ADE rates (p = .02). The adjusted cumulative risk of an AE per PICU day was 5.3% and 1.6% for an ADE alone. There was a 4% increase in adjusted ADEs rates for every year increase in age.
AEs and ADEs occur frequently in the PICU setting. These data provide areas of focus for evidence-based prevention strategies to decrease the substantial risk to this vulnerable pediatric population.
为了选择相关的患者安全干预措施，需要确定儿科重症监护病房（PICU）中发生的不良事件（AE）和药物不良事件（ADE）的类型和严重程度。本研究的目的是：1）确定 PICU 患者 AE/ADE 的发生率，包括类型、严重程度和可预防程度；2）确定与 AE/ADE 风险增加相关的人群特征；3）制定并测试一种特定于 PICU 的触发工具，以方便识别 AE/ADE。
设计、地点、患者：2005 年 9 月至 12 月期间，对从美国 15 个 PICU 出院的 734 名患者的病历进行回顾性、横断面、随机回顾。
一种新的用于 AE/ADE 检测的 PICU 特异性触发工具。
62%的 PICU 患者至少有一次 AE。共发现 1488 次 AE，其中 256 次为 ADE，相当于每 100 个患者日发生 28.6 次 AE 和 4.9 次 ADE。最常见的 AE 类型是导管并发症、疼痛失控和气管插管位置不当。10%的 AE 被归类为危及生命或永久性的；45%被认为是可预防的。手术患者的 AE 发生率较高（p =.02），在 PICU 期间插管的患者（p =.002）和死亡的患者（p <.001）。手术患者的可预防 AE（p =.01）和 ADE 发生率较高（p =.02）。每增加 1 天 PICU 天数，AE 的调整后累积风险为 5.3%，单独发生 ADE 的风险为 1.6%。年龄每增加 1 岁，调整后的 ADE 发生率增加 4%。
AE 和 ADE 在 PICU 中经常发生。这些数据为基于证据的预防策略提供了重点领域，以降低这一脆弱的儿科人群的巨大风险。
