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Identification of adverse events in pediatric severe traumatic brain injury patients to target evidence-based prevention for increased performance improvement and patient safety

  • Tanyak Charyk Stewart
    Correspondence
    Corresponding author at: Research Park, University of Western Ontario, Rm LL02, 999 Collip Circle, London N6G 0J3, ON, Canada.
    Affiliations
    Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada

    Children's Hospital at London Health Sciences Centre, London, ON, Canada
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  • Kyle Luong
    Affiliations
    Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada

    Children's Hospital at London Health Sciences Centre, London, ON, Canada
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  • Ibrahim Alharfi
    Affiliations
    Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada

    Children's Hospital at London Health Sciences Centre, London, ON, Canada
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  • Brianna McKelvie
    Affiliations
    Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada

    Children's Hospital at London Health Sciences Centre, London, ON, Canada
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  • Douglas D. Fraser
    Affiliations
    Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada

    Children's Hospital at London Health Sciences Centre, London, ON, Canada

    Translational Research Centre, London, ON, Canada

    Children's Health Research Institute, London, ON, Canada

    Physiology and Pharmacology, Western University, London, ON, Canada

    Clinical Neurological Sciences, Western University, London, ON, Canada
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      Highlights

      • Merging databases is an effective practice to identify AE and patient safety risks in trauma populations for evidence-based practice.
      • Found a PICU AE rate of 1.23 events/patient, decubitus ulcers most common (15%), with TBI severity the most important factor to increase odds of AE.
      • First study to report higher median costs for PICU AE patients ($121,234 vs. $53,341 no AE; p=0.031) in this high acuity pediatric sTBI population.
      • Regular AE monitoring demonstrates the Trauma Registry supports the performance improvement process for ACS verification.
      • It promotes performance improvement by implementing targeted, evidence-based prevention strategies to optimize patient outcomes and safety.

      Abstract

      Introduction

      Trauma centres are required to continuously measure, evaluate and improve care. Severe traumatic brain injury (sTBI) patients are highly susceptible to adverse events (AE; unintended, potentially harmful events resulting from health care) due to their unstable condition requiring high risk interventions, multiple medications and invasive monitoring. Objectives were to describe: (1) a process for identifying AE in pediatric sTBI patients to identify safety risks, target and implement evidence-based prevention strategies; and (2) a tertiary care PICU's sTBI AE experience.

      Methods

      Merging databases, Trauma Registry with Adverse Events Management System, identified AE in patients. Details on the event location, type and severity of harm were combined with patient demographics, injury data, costs and outcomes in a cohort of 193 PICU sTBI patients (2000-15). Descriptive statistics and multivariate logistic regression were undertaken to describe AE, and their association with risk factors and outcomes.

      Results

      103/193 sTBI patients (53%) suffered at least one AE. 238 AE occurred (1.23 AE/patient), with 30% of patients having 2+ AE. Most resulted in no harm (54%) with decubitus ulcers (15%) the most common AE. AE patients were more likely to be monitored for elevated ICP (p<0.001), with fewer ventilator-free days (p=0.015), longer LOS for PICU (11 vs. 3.5 days; p<0.001) and in-hospital (31 vs. 11 days; p<0.001) with higher median costs ($121,234 vs. $53,341; p=0.031). AE patients required a higher level of care on discharge (p=0.035).

      Conclusions

      Merging databases is an effective practice to identify AE and safety risks in trauma populations. Utilizing this method, a PICU AE rate of 1.23 events per patient was found with TBI severity the most important factor to increase the odds of AE. AE represent performance improvement events, opportunities to optimize care, decrease costs, as well as improve outcomes, to ultimately improve patient safety in this vulnerable population.

      Keywords

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