Medical injuries among hospitalized children

• Published in: Quality & safety in health care Vol. 15; no. 3; pp. 202 - 207
• Main Authors: Meurer, J R, Yang, H, Guse, C E, Scanlon, M C, Layde, P M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.06.2006; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adolescent; Agency for Healthcare Research and Quality; AHRQ; All Patient Refined-Diagnosis Related Groups; Analgesics; APR-DRG; Child; Child, Preschool; children; Classification; Cross-Sectional Studies; Diagnosis related groups; Disease prevention; DRGs; Female; Health care; Health surveillance; Hospitalization; Hospitals; Hospitals, General - statistics & numerical data; Humans; Iatrogenic Disease - epidemiology; Infant; Infant, Newborn; Injuries; Injury Severity Score; length of stay; Length of Stay - statistics & numerical data; LOS; Male; medical injuries; Medical records; Mortality; Original; Outcome Assessment, Health Care - statistics & numerical data; Patient Discharge - statistics & numerical data; Patient safety; patient safety indicator; Pediatrics; Poisoning; Prevention programs; Prostheses and Implants - adverse effects; PSI; Public health; Quality; Radiation Injuries - epidemiology; Safety; Studies; Transplants & implants; United States; United States Agency for Healthcare Research and Quality; Wisconsin - epidemiology; Wisconsin Medical Injury Prevention Program; WMIPP; Wounds and Injuries - epidemiology; United States; Wisconsin; United States > US; USA, Wisconsin
• ISSN: 1475-3898; 1475-3901
• DOI: 10.1136/qshc.2005.015412

Background: Inpatient medical injuries among children are common and result in a longer stay in hospital and increased hospital charges. However, previous studies have used screening criteria that focus on inpatient occurrences only rather than on injuries that also occur in ambulatory or community settings leading to hospital admission. Objective: To describe the incidence and outcomes of medical injuries among children hospitalized in Wisconsin using the Wisconsin Medical Injury Prevention Program (WMIPP) screening criteria. Methods: Cross sectional analysis of discharge records of 318 785 children from 134 hospitals in Wisconsin between 2000 and 2002. Results: The WMIPP criteria identified 3.4% of discharges as having one or more medical injuries: 1.5% due to medications, 1.3% to procedures, and 0.9% to devices, implants and grafts. After adjusting for the All Patient Refined-Diagnosis Related Groups disease category, illness severity, mortality risk, and clustering within hospitals, the mean length of stay (LOS) was a half day (12%) longer for patients with medical injuries than for those without injuries. The similarly adjusted mean total hospital charges were $1614 (26%) higher for the group with medical injuries. Excess LOS and charges were greatest for injuries due to genitourinary devices/implants, vascular devices, and infections/inflammation after procedures. Conclusions: This study reinforces previous national findings up to 2000 using Wisconsin data to the end of 2002. The results suggest that hospitals and pediatricians should focus clinical improvement on medications, procedures, and devices frequently associated with medical injuries and use medical injury surveillance to track medical injury rates in children.