Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
J Pediatr Gastroenterol Nutr. 2024 Jul;79(1):154-160. doi: 10.1002/jpn3.12254. Epub 2024 May 20.
To develop a semiautomated electronic medical record (EMR) system to track pediatric endoscopic procedural adverse event (AE) at a tertiary referral children's hospital.
We developed an automated EMR based query for postprocedure AEs. Main outcome measurements within 30 days of procedure: return to emergency department, return to surgery, unplanned admissions and admissions with longer than intended stays. Events were graded using a recently described classification system for postendoscopy events and tracked for a 36-month period, from January 2017 to December 2019.
Development of a semi-automated system was successful in comprehensive identification of endoscopy and sedation related AE. A total of 193 AEs (2%) were identified in all three categories. Seventy cases (0.7%) were noted to be a direct result of an endoscopic procedure. Of these cases, 31 (44%) were noted to be Grade 3, 5 cases (7%) Grade 4, and no Grade 5 AE occured. Higher rates of AE were observed after therapeutic procedures versus diagnostic (2.6% vs. 0.3%, p = <0.00001). AEs related to sedation occurred in 0.5% of procedures with the majority (84%) reported in patients with American Society of Anesthesia classification of 3 or greater.
Diagnostic endoscopy remains a safe procedure and risk of both endoscopy and sedation related AE are low. Therapeutic procedures carry a higher risk but are still overwhelmingly safe. Institutional investment in this EMR based system allowed for sustainability and comprehensive tracking of endoscopy related AE.
开发一种半自动化电子病历（EMR）系统，以跟踪三级转诊儿童医院的儿科内镜程序不良事件（AE）。
我们开发了一种基于自动 EMR 的术后 AE 查询。主要结局测量指标为术后 30 天内：返回急诊部、返回手术室、计划外入院和住院时间延长。使用最近描述的内镜后事件分类系统对事件进行分级，并在 2017 年 1 月至 2019 年 12 月的 36 个月内进行跟踪。
半自动化系统的开发成功全面识别了内镜和镇静相关 AE。在所有三个类别中总共发现了 193 例 AE（2%）。有 70 例（0.7%）被认为是内镜程序的直接结果。在这些病例中，31 例（44%）为 3 级，5 例（7%）为 4 级，未发生 5 级 AE。治疗性程序的 AE 发生率高于诊断性程序（2.6% vs. 0.3%，p<0.00001）。与镇静相关的 AE 发生在 0.5%的程序中，其中大多数（84%）发生在 ASA 分级为 3 级或更高的患者中。
诊断性内镜仍然是一种安全的程序，内镜和镇静相关 AE 的风险都很低。治疗性程序的风险更高，但仍然是非常安全的。机构对这种基于 EMR 的系统的投资使其具有可持续性，并能够全面跟踪内镜相关 AE。
