Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study)

T. Engelhardt; D. Ayansina; G. T. Bell; V. Oshan; J. S. Rutherford; N. S. Morton; APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network

doi:10.1111/anae.14520

Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study)

T. Engelhardt, D. Ayansina, G. T. Bell, V. Oshan, J. S. Rutherford, N. S. Morton (Corresponding Author), APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network

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Abstract

The anaesthesia practice in children observational trial of 31,127 patients in 261 European hospitals revealed a high (5.2%) incidence of severe critical events in the peri-operative period and wide variability in practice. A sub-analysis of the UK data was undertaken to investigate differences compared with the non-UK cohort in the incidence and nature of peri-operative severe critical events and to attempt to identify areas for quality improvement. In the UK cohort of 7040 paediatric patients from 43 hospitals, the overall incidence of perioperative severe critical events was lower than in the non-UK cohort (3.3%, 95%CI: 2.9–3.8 vs. 5.8%, 95%CI: 5.5– 6.1, RR 0.57, p < 0.001). There was a lower rate of bronchospasm (RR 0.22, 95%CI: 0.14–0.33; p < 0.001), stridor (RR 0.42, 95%CI: 0.28–0.65; p < 0.001) and cardiovascular instability (RR 0.69, 95%CI: 0.55–0.86; p = 0.001) than in the non-UK cohort. The proportion of sicker patients where less experienced teams were managing care was lower in the UK than in the non-UK cohort (10.4% vs. 20.4% of the ASA physical status 3 and 9% vs. 12.9% of the ASA physical status 4 patients). Differences in work-load between centres did not affect the incidence and outcomes of severe critical events when stratified for age and ASA physical status. The lower incidence of cardiovascular and respiratory complications could be partly attributed to more experienced dedicated paediatric anaesthesia providers managing the higher risk patients in the UK. Areas for quality improvement include: standardisation of serious critical event definitions; increased reporting; development of evidence-based protocols for management of serious critical events; development and rational use of paediatric peri-operative risk assessment scores; implementation of current best practice in provision of competent paediatric anaesthesia services in Europe; development of specific training in the management of severe peri-operative critical events; and implementation of systems for ensuring maintenance of skills.

Original language	English
Pages (from-to)	300-311
Number of pages	12
Journal	Anaesthesia
Volume	74
Issue number	3
Early online date	10 Dec 2018
DOIs	https://doi.org/10.1111/anae.14520
Publication status	Published - Mar 2019

Bibliographical note

APRICOT was registered with ClinicalTrials.gov (NCT01878760). The funding source (ESA) provided the infrastructure for the trial. The UK national study
coordinating investigator (NM), liaised with the local investigators regarding their ethics submission process and the inclusion period, and monitored the data entry and cleaning. A UK-wide waiver for individual patient/family consent was granted and Caldicott guardian approval was given for data management, anonymisation procedures and data security. Authors NM, TE and DA had full access to all UK data in the study and had the final responsibility for the decision to submit the manuscript. The ESA principal investigators approved the manuscript content before submission.

Keywords

critical incident reporting
paediatric anaesthesia
quality improvement
SYSTEM
QUALITY IMPROVEMENT
MEDICATION ERRORS
UK
RISK
SAFE ANESTHESIA

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10.1111/anae.14520Licence: Unspecified

Accepted Manuscript
This is the peer reviewed version of the following article: Engelhardt, T. , Ayansina, D. , Bell, G. T., Oshan, V. , Rutherford, J. S., Morton, N. S. and , (2019), Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study). Anaesthesia, 74: 300-311, which has been published in final form at https://doi.org/10.1111/anae.14520. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Accepted author manuscript, 435 KBLicence: Unspecified

Cite this

Engelhardt, T., Ayansina, D., Bell, G. T., Oshan, V., Rutherford, J. S., Morton, N. S., & APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network (2019). Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study). Anaesthesia, 74(3), 300-311. https://doi.org/10.1111/anae.14520

Engelhardt, T, Ayansina, D, Bell, GT, Oshan, V, Rutherford, JS, Morton, NS & APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network 2019, 'Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study)', Anaesthesia, vol. 74, no. 3, pp. 300-311. https://doi.org/10.1111/anae.14520

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abstract = "The anaesthesia practice in children observational trial of 31,127 patients in 261 European hospitals revealed a high (5.2%) incidence of severe critical events in the peri-operative period and wide variability in practice. A sub-analysis of the UK data was undertaken to investigate differences compared with the non-UK cohort in the incidence and nature of peri-operative severe critical events and to attempt to identify areas for quality improvement. In the UK cohort of 7040 paediatric patients from 43 hospitals, the overall incidence of perioperative severe critical events was lower than in the non-UK cohort (3.3%, 95%CI: 2.9–3.8 vs. 5.8%, 95%CI: 5.5– 6.1, RR 0.57, p < 0.001). There was a lower rate of bronchospasm (RR 0.22, 95%CI: 0.14–0.33; p < 0.001), stridor (RR 0.42, 95%CI: 0.28–0.65; p < 0.001) and cardiovascular instability (RR 0.69, 95%CI: 0.55–0.86; p = 0.001) than in the non-UK cohort. The proportion of sicker patients where less experienced teams were managing care was lower in the UK than in the non-UK cohort (10.4% vs. 20.4% of the ASA physical status 3 and 9% vs. 12.9% of the ASA physical status 4 patients). Differences in work-load between centres did not affect the incidence and outcomes of severe critical events when stratified for age and ASA physical status. The lower incidence of cardiovascular and respiratory complications could be partly attributed to more experienced dedicated paediatric anaesthesia providers managing the higher risk patients in the UK. Areas for quality improvement include: standardisation of serious critical event definitions; increased reporting; development of evidence-based protocols for management of serious critical events; development and rational use of paediatric peri-operative risk assessment scores; implementation of current best practice in provision of competent paediatric anaesthesia services in Europe; development of specific training in the management of severe peri-operative critical events; and implementation of systems for ensuring maintenance of skills.",

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note = "APRICOT was registered with ClinicalTrials.gov (NCT01878760). The funding source (ESA) provided the infrastructure for the trial. The UK national study coordinating investigator (NM), liaised with the local investigators regarding their ethics submission process and the inclusion period, and monitored the data entry and cleaning. A UK-wide waiver for individual patient/family consent was granted and Caldicott guardian approval was given for data management, anonymisation procedures and data security. Authors NM, TE and DA had full access to all UK data in the study and had the final responsibility for the decision to submit the manuscript. The ESA principal investigators approved the manuscript content before submission.",

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N2 - The anaesthesia practice in children observational trial of 31,127 patients in 261 European hospitals revealed a high (5.2%) incidence of severe critical events in the peri-operative period and wide variability in practice. A sub-analysis of the UK data was undertaken to investigate differences compared with the non-UK cohort in the incidence and nature of peri-operative severe critical events and to attempt to identify areas for quality improvement. In the UK cohort of 7040 paediatric patients from 43 hospitals, the overall incidence of perioperative severe critical events was lower than in the non-UK cohort (3.3%, 95%CI: 2.9–3.8 vs. 5.8%, 95%CI: 5.5– 6.1, RR 0.57, p < 0.001). There was a lower rate of bronchospasm (RR 0.22, 95%CI: 0.14–0.33; p < 0.001), stridor (RR 0.42, 95%CI: 0.28–0.65; p < 0.001) and cardiovascular instability (RR 0.69, 95%CI: 0.55–0.86; p = 0.001) than in the non-UK cohort. The proportion of sicker patients where less experienced teams were managing care was lower in the UK than in the non-UK cohort (10.4% vs. 20.4% of the ASA physical status 3 and 9% vs. 12.9% of the ASA physical status 4 patients). Differences in work-load between centres did not affect the incidence and outcomes of severe critical events when stratified for age and ASA physical status. The lower incidence of cardiovascular and respiratory complications could be partly attributed to more experienced dedicated paediatric anaesthesia providers managing the higher risk patients in the UK. Areas for quality improvement include: standardisation of serious critical event definitions; increased reporting; development of evidence-based protocols for management of serious critical events; development and rational use of paediatric peri-operative risk assessment scores; implementation of current best practice in provision of competent paediatric anaesthesia services in Europe; development of specific training in the management of severe peri-operative critical events; and implementation of systems for ensuring maintenance of skills.

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Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study)

Abstract

Bibliographical note

Keywords

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