Disparities in Adverse Event Reporting for Hospitalized Children.

OBJECTIVES: Hospitals rely on voluntary event reporting (VER) for adverse event (AE) identification, although it captures fewer events than a trigger tool, such as Global Assessment of Pediatric Patient Safety (GAPPS). Medical providers exhibit bias based on patient weight status, race, and English proficiency. We compared the AE rate identified by VER with that identified using the GAPPS between hospitalized children by weight category, race, and English proficiency. METHODS: We identified a cohort of patients 2 years to younger than 18 years consecutively discharged from an academic children's hospital between June and October 2018. We collected data on patient weight status from age, sex, height, and weight, race/ethnicity by self-report, and limited English proficiency by record of interpreter use. We reviewed each chart with the GAPPS to identify AEs and reviewed VER entries for each encounter. We calculated an AE rate per 1000 patient-days using each method and compared these using analysis of variance. RESULTS: We reviewed 834 encounters in 680 subjects; 262 (38.5%) had overweight or obesity, 144 (21.2%) identified as Black, and 112 (16.5%) identified as Hispanic; 82 (9.8%) of encounters involved an interpreter. We identified 288 total AEs, 270 (93.8%) by the GAPPS and 18 (6.3%) by VER. A disparity in AE reporting was found for children with limited English proficiency, with fewer AEs by VER ( P = 0.03) compared with no difference in AEs by GAPPS. No disparities were found by weight category or race. CONCLUSIONS: Voluntary event reporting may systematically underreport AEs in hospitalized children with limited English proficiency.

Body Mass Index Category and Adverse Events in Hospitalized Children.

OBJECTIVE: To identify associations between patient body mass index (BMI) category and adverse event (AE) rate, severity, and preventability in a cohort of children discharged from an academic children's hospital. METHODS: We identified patients 2 to 17 years old consecutively discharged between June and October 2018. Patient age, sex, height, and weight were used to categorize patients as having underweight, normal weight, overweight, or obesity. We used the Global Assessment of Pediatrics Patient Safety trigger tool to identify AEs, which were scored for harm and preventability. The primary outcome was the rate of AEs; these were compared with Poisson regression. We used multivariable logistic regression to model event preventability. RESULTS: We reviewed 834 encounters in 680 subjects; 51 (7.5%) had underweight, 367 (54.0%) had normal weight, 112 (16.5%) had overweight, and 150 (22.1%) had obesity. Our cohort experienced 270 AEs, with an overall rate of 69.7 (61.8-78.5) AEs per 1000 patient-days: 67.7 (46.4-98.7) in underweight, 70.0 (59.4-82.4) in normal weight, 58.6 (42.5-79.7) in overweight, and 80.4 (62.5-103.6) in obesity, P = .46. No associations were seen between BMI category and AE severity. Children with obesity had an increased rate of preventable AEs (P < .01), but this association did not persist in the multivariable model. CONCLUSIONS: In this single-center study, we did not find associations between BMI category and rate, severity, or preventability of AEs.

Clinical characteristics associated with increased resource utilization of hospitalized children under 5 years with acute gastroenteritis at a tertiary hospital in the northern region of Ghana: a retrospective study.

INTRODUCTION: Acute gastroenteritis (AGE) is a leading cause of mortality in children in developing countries. Management of AGE consumes medical resources, including antibiotics and intra-venous fluids, but factors affecting resource utilization in the management of AGE are under-studied. We hope to identify clinical predictors of resource utilization in AGE. METHODS: We performed a retrospective chart review of patients 1-60 months of age admitted to a tertiary hospital in Northern Ghana between January 2013 and December 2014 with an admitting diagnosis of AGE. We collected data on patient demographics, presenting symptoms, and subsequent management. Our primary outcome was prolonged hospital length of stay, defined as >4 days. Secondary outcomes included other measures of resource utilization, such as use of antibiotics, antimalarials and intravenous fluids. Demographic and clinical characteristics were compared between groups with Pearson chi square test for categorical variables and ANOVA for continuous variables. Multivariable logistic regression modeling for each outcome included all variables found to be significant in the bivariate analysis. RESULTS: We reviewed charts for 473 patients admitted for AGE during this timeframe. 264 (56%) were male, median age was 12 months. 448 (95%) received antibiotics, 396 (84%) received antimalarials and 365 (77.2%) received intravenous fluids. 167 (35.3%) had prolonged LOS >4 days. Following multiple logistic regression analysis, clinical features associated with prolonged LOS included fever duration (OR 2.87, 95% CI 2.28-3.61 per 1-day increase), mild (OR 2.39, 95% CI 1.12-5.08) or moderate (OR 3.13, 95% CI 1.57-6.21) dehydration (compared to none) and symptom duration (OR 1.13, 95% CI 1.01-1.27 per 1-day increase). CONCLUSION: Dehydration and duration of symptoms prior to presentation predict prolonged hospital LOS in young children with AGE in Northern Ghana.

Association of NPO Status and Type of Nutritional Support on Weight and Length of Stay in Infants Hospitalized With Bronchiolitis.

OBJECTIVES: We investigated the association of nil per os (NPO) status and subsequent nutritional support with patient weight and length of stay (LOS) during admission for bronchiolitis in patients <2 years old. METHODS: A retrospective chart review was performed of all patients <2 years old admitted to an academic pediatric hospital between November 2009 and June 2011 with a Current Procedural Terminology code of bronchiolitis. Data extracted from the medical record included respiratory rate, per os/NPO status, use of intravenous fluids, use of enteral tube feedings, weight, and LOS. Patients who did not have 2 weights recorded were excluded. The major outcome measures were weight change during admission and LOS. RESULTS: The study included 149 patients. The mean ± SD patient age was 3.7 ± 3.8 months, with a median age of 2 months. The median length of stay was 4 days (interquartile range: 3-6). Overall, 16% of patients were made NPO, 75% received intravenous fluids, and 9% received enteral tube feedings. The mean weight loss for all patients was 38 (289) g during the hospitalization, which was not statistically significant. No significant association was found between weight loss and LOS, per os/NPO status, or use of intravenous fluids. However, NPO status was associated with a significant increase in LOS. CONCLUSIONS: The infants admitted for bronchiolitis did not demonstrate weight loss in this study; however, an association was seen between NPO status and prolonged LOS.