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BACKGROUND: Despite the high number of children treated in emergency departments, patient safety risks in this setting are not well quantified. Our objective was to estimate the risk and type of adverse events, as well as their preventability and severity, for children treated in a paediatric emergency department. METHODS: Our prospective, multicentre cohort study enrolled children presenting for care during one of 168 8-hour study shifts across nine paediatric emergency departments. Our primary outcome was an adverse event within 21 days of enrolment which was related to care provided at the enrolment visit. We identified 'flagged outcomes' (such as hospital visits, worsening symptoms) through structured telephone interviews with patients and families over the 21 days following enrolment. We screened admitted patients' health records with a validated trigger tool. For patients with flags or triggers, three reviewers independently determined whether an adverse event occurred. RESULTS: We enrolled 6376 children; 6015 (94%) had follow-up data. Enrolled children had a median age of 4.3 years (IQR 1.6-9.8 years). One hundred and seventy-nine children (3.0%, 95% CI 2.6% to 3.5%) had at least one adverse event. There were 187 adverse events in total; 143 (76.5%, 95% CI 68.9% to 82.7%) were deemed preventable. Management (n=98, 52.4%) and diagnostic issues (n=36, 19.3%) were the most common types of adverse events. Seventy-nine (42.2%) events resulted in a return emergency department visit; 24 (12.8%) resulted in hospital admission; and 3 (1.6%) resulted in transfer to a critical care unit. CONCLUSION: In this large-scale study, 1 in 33 children treated in a paediatric emergency department experienced an adverse event related to the care they received there. The majority of events were preventable; most were related to management and diagnostic issues. Specific patient populations were at higher risk of adverse events. We identify opportunities for improvement in care.
RESUMO
OBJECTIVE: The objectives of this study were to describe the prevalence of dyslipidemia in a population of youth with type 2 diabetes mellitus (T2DM) and to examine the relationship between the lipid parameters and other known cardiovascular risk factors. METHODS: Ninety-nine youth aged 7-17 yr with T2DM had a fasting blood sample for lipid and lipoprotein levels [total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol, triglycerides (TG)], apolipoprotein B (apoB), blood glucose, and hemoglobin A1c (HbA1(C)). Lipid profiles were compared with a non-diabetic population of Canadian First Nation (FN) youth and to published reference data. Rates of obesity, hypertension, smoking, and poor glycemic control were recorded and the relationship between these cardiovascular risk factors and lipid patterns was analyzed. RESULTS: Fifty-seven percent of the subjects were female and 95% were of self-declared FN heritage. The mean levels of all components of the lipid profile were elevated in the group with T2DM compared with the control population (p < 0.001). ApoB levels exceeded the 75th %ile of the control population in 72% of those with T2DM. Thirty-seven percent of those with T2DM had elevated TG and apoB levels. Forty percent were smokers. Fifty-nine percent had an HbA1(C) that was greater than 7.0%. Thirty-nine percent had a BMI z-score >/= 2 but less than 15% had systolic hypertension. CONCLUSIONS: Atherogenic lipid profiles are common in youth with T2DM. Elevated apoB levels with normal LDL-c levels highlight the importance of a full lipid panel including apoB in defining potential modifiable cardiovascular risk in this population with high rates of obesity, smoking, and poor glycemic control.