Source:

Stockwell
DC
,
Landrigan
CP
,
Toomey
SL
, et al
.
Racial, ethnic, and socioeconomic disparities in patient safety events for hospitalized children
.
Hosp Pediatr.
2019
;
9
(
1
):
1
5
; doi:
https://doi.org/10.1542/hpeds.2018-0131

Investigators at multiple institutions conducted a chart review to assess the prevalence of inpatient adverse events (AEs) in different populations. Medical records of patients who were discharged from 1 of 16 hospitals belonging to the Pediatric Research in Inpatient Settings Network from 2007–2012 were randomly selected for review. A study investigator applied a validated tool to identify AEs by using elements of the medical record. Two additional investigators independently reviewed and adjudicated each identified AE. Severity of confirmed AEs was assessed using National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) standards. Preventability of the AE was rated on a 4-point Likert scale.

The primary predictor variables were race/ethnicity and insurance status, both obtained from the medical record. Race/ethnicity was categorized as black, white, Latino, and other. Insurance status was categorized as public, private, and self-pay or no insurance. The primary outcome was prevalence of AEs per 1,000 patient days. Secondary outcomes were prevalence of preventable and high-severity (defined using NCC MERP severity category classifications) AEs per 1,000 patient days. Regression models were used to assess the association of these outcomes with each predictor.

There were 3,790 medical records reviewed and 413 AEs identified. Of these, 196 (47%) were high-severity and 209 (51%) preventable AEs. There was a significant difference in Latino (vs white) patients in the prevalence of overall AEs (30.1 vs 16.9 AEs per 1,000 patient days; P≤.001), high-severity AEs (12.6 vs 7.7 AEs per 1,000 patient days; P=.02), and preventable AEs (15.9 vs 8.9 AEs per 1,000 patient days; P=.002). There were no significant differences in AEs across other race/ethnicity groups. Regarding insurance status, there was a significant difference in patients with public (vs private) insurance in the prevalence of preventable AEs (12.1 vs 8.5 AEs per 1,000 patient days; P=.02).

The investigators conclude that disparities in AEs exist in the pediatric inpatient setting among racial or ethnic and socioeconomic groups.

Dr Winer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Preventing inpatient AEs is a complex subject. One of the first difficulties is identifying AEs. The tool used in the current study, the Global Assessment of Pediatric Patient Safety (GAPPS) trigger tool, was previously validated by the same study group. The GAPPS trigger tool theoretically is able to remove the limitations and bias inherent in reporting AEs. The results of a validation study estimated the GAPPS trigger tool, coupled with local review of cases, had a 40% sensitivity and a 91% specificity with good concordance.

If we accept that the AEs found are valid, then the next issue is trying to link demographic differences to differences in AEs through a feasible...

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