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Birth trauma involving long bone and skull fractures is the most common pediatric adverse event.

Patient Safety Monitor Alert, June 10, 2004

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Birth trauma involving long bone and skull fractures is the most common pediatric adverse event. Children also suffer from post-operative infections and obstetrical complications that involve the mother, such as difficulties with anesthesia, according to the first national study that attempts to quantify the burden of patient safety incidents on children.

The study, published in the June issue of Pediatrics, reveals that hospitalized children experience rates of medical errors similar to those of hospitalized adults. Birth trauma shows the highest rate of pediatric adverse events, with 1.5 occurring per 1,000 births.

Researchers from the Agency for Healthcare Research and Quality (AHRQ) analyzed 3.8 million pediatric discharge records from 22 states in 1997, which accounted for approximately 70% of all children hospitalized in the U.S. during that year.

They found that pediatric patients who experienced adverse events had up to a six times longer hospital stay and as many as 18 times the rates of death compared to children who did not experience such incidents. The rates are comparable to those seen for adults, says lead study author Marlene Miller, MD, MSc, formerly with AHRQ and now director of quality and safety initiatives at the Johns Hopkins Children's Center.

"Attention needs to be paid to the unique event of childbirth and how health providers can prevent such incidents from occurring during this experience," says Miller. "Children have a near universal hospitalization for birth, are not able to directly question their own care, and, if their parents or guardians are unavailable, are unable to provide authorized consent for some types of medical care, meaning a possible delay to treatment."

Miller and her team analyzed pediatric discharge records using the AHRQ's established Patient Safety Indicators (PSIs), a set of administrative, data-based indicators providing information on potential in-hospital complications and adverse events following surgeries, procedures, and childbirth.

Among other findings

• More than 4,000 children died in 2000 due to lapses or errors.
  
• The errors cost more than $1 billion in extra hospital charges from longer stays and follow-up care. Hospital-acquired infections, for example, added an extra month to a child's length of stay and cost an additional $30,000 to $140,000 in each case.
  
• Common problems included obstetric trauma, failure to resuscitate, and postoperative sepsis. 
  
• The youngest and poorest patients were the most vulnerable.

The researchers did not analyze medication errors-one of the most common types of medical mistakes-which means that the overall impact of patient safety problems could be much greater. The statistics also apply only to care delivered in hospitals.

On a slightly different note, close to 40% of obstetrician/gynecologists working in states with high malpractice premiums are no longer delivering babies, according to a survey by Merritt, Hawkins & Associates, a national physician search firm based in Dallas. States with high malpractice premiums include Texas, New York, Washington, Ohio, Pennsylvania, and Florida.

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