Jaimes Camilo, Murcia Diana J, Miguel Karen, DeFuria Cathryn, Sagar Pallavi, Gee Michael S
Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Pediatr Radiol. 2018 Jan;48(1):66-73. doi: 10.1007/s00247-017-3989-4. Epub 2017 Oct 19.
Analysis of safety reports has been utilized to guide practice improvement efforts in adult magnetic resonance imaging (MRI). Data specific to pediatric MRI could help target areas of improvement in this population.
To estimate the incidence of safety reports in pediatric MRI and to determine associated risk factors.
In a retrospective HIPAA-compliant, institutional review board-approved study, a single-institution Radiology Information System was queried to identify MRI studies performed in pediatric patients (0-18 years old) from 1/1/2010 to 12/31/2015. The safety report database was queried for events matching the same demographic and dates. Data on patient age, gender, location (inpatient, outpatient, emergency room [ER]), and the use of sedation/general anesthesia were recorded. Safety reports were grouped into categories based on the cause and their severity. Descriptive statistics were used to summarize continuous variables. Chi-square analyses were performed for univariate determination of statistical significance of variables associated with safety report rates. A multivariate logistic regression was used to control for possible confounding effects.
A total of 16,749 pediatric MRI studies and 88 safety reports were analyzed, yielding a rate of 0.52%. There were significant differences in the rate of safety reports between patients younger than 6 years (0.89%) and those older (0.41%) (P<0.01), sedated (0.8%) and awake children (0.45%) (P<0.01), and inpatients (1.1%) and outpatients (0.4%) (P<0.01). The use of sedation/general anesthesia is an independent risk factor for a safety report (P=0.02). The most common causes for safety reports were service coordination (34%), drug reactions (19%), and diagnostic test and ordering errors (11%).
The overall rate of safety reports in pediatric MRI is 0.52%. Interventions should focus on vulnerable populations, such as younger patients, those requiring sedation, and those in need of acute medical attention.
对安全报告的分析已被用于指导成人磁共振成像（MRI）的实践改进工作。儿科MRI的特定数据有助于确定该人群中需要改进的领域。
估计儿科MRI安全报告的发生率，并确定相关风险因素。
在一项符合健康保险流通与责任法案（HIPAA）且经机构审查委员会批准的回顾性研究中，查询了单机构放射学信息系统，以识别2010年1月1日至2015年12月31日期间对儿科患者（0至18岁）进行的MRI检查。在安全报告数据库中查询与相同人口统计学特征和日期匹配的事件。记录患者年龄、性别、地点（住院、门诊、急诊室[ER]）以及镇静/全身麻醉的使用情况。安全报告根据原因及其严重程度进行分类。使用描述性统计来总结连续变量。进行卡方分析以单变量确定与安全报告率相关变量的统计学意义。使用多变量逻辑回归来控制可能的混杂效应。
共分析了16749例儿科MRI检查和88份安全报告，发生率为0.52%。6岁以下患者（0.89%）与6岁以上患者（0.41%）（P<0.01）、接受镇静的患者（0.8%）与清醒儿童（0.45%）（P<0.01）以及住院患者（1.1%）与门诊患者（0.4%）（P<0.01）的安全报告率存在显著差异。使用镇静/全身麻醉是安全报告的独立风险因素（P=0.02）。安全报告最常见的原因是服务协调（34%）、药物反应（19%）以及诊断检查和医嘱错误（11%）。
儿科MRI安全报告的总体发生率为0.52%。干预措施应侧重于弱势群体，如年幼患者、需要镇静的患者以及需要紧急医疗护理的患者。
