Medical errors in hospitalized pediatric trauma patients with chronic health conditions

Xiaotong Liu; Han Yin; Junxin Shi; Krista Kurz Wheeler; Jonathan I Groner; Huiyun Xiang

doi:10.1177/2050312113519987

Medical errors in hospitalized pediatric trauma patients with chronic health conditions

SAGE Open Med. 2014 Jan 30:2:2050312113519987. doi: 10.1177/2050312113519987. eCollection 2014.

Authors

Xiaotong Liu¹, Han Yin¹, Junxin Shi², Krista Kurz Wheeler², Jonathan I Groner³, Huiyun Xiang⁴

Affiliations

¹ Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University, Columbus, OH, USA.
² Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
³ Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Trauma Program, Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; College of Medicine, The Ohio State University, Columbus, OH, USA.
⁴ Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; College of Medicine, The Ohio State University, Columbus, OH, USA.

Abstract

Objective: This study compares medical errors in pediatric trauma patients with and without chronic conditions.

Methods: The 2009 Kids' Inpatient Database, which included 123,303 trauma discharges, was analyzed. Medical errors were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The medical error rates per 100 discharges and per 1000 hospital days were calculated and compared between inpatients with and without chronic conditions.

Results: Pediatric trauma patients with chronic conditions experienced a higher medical error rate compared with patients without chronic conditions: 4.04 (95% confidence interval: 3.75-4.33) versus 1.07 (95% confidence interval: 0.98-1.16) per 100 discharges. The rate of medical error differed by type of chronic condition. After controlling for confounding factors, the presence of a chronic condition increased the adjusted odds ratio of medical error by 37% if one chronic condition existed (adjusted odds ratio: 1.37, 95% confidence interval: 1.21-1.5), and 69% if more than one chronic condition existed (adjusted odds ratio: 1.69, 95% confidence interval: 1.48-1.53). In the adjusted model, length of stay had the strongest association with medical error, but the adjusted odds ratio for chronic conditions and medical error remained significantly elevated even when accounting for the length of stay, suggesting that medical complexity has a role in medical error. Higher adjusted odds ratios were seen in other subgroups.

Conclusion: Chronic conditions are associated with significantly higher rate of medical errors in pediatric trauma patients. Future research should evaluate interventions or guidelines for reducing the risk of medical errors in pediatric trauma patients with chronic conditions.

Keywords: Medical errors; children; chronic conditions; pediatric; trauma.