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Patient safety problems in hospitalized children are substantial

Children experienced a substantial number of potentially preventable patient safety problems during hospital stays in 1997, according to a new study conducted by researchers at the Agency for Healthcare Research and Quality. This first, comprehensive examination of the types of patient safety problems that children experience in hospitals found that the rates of such problems range from 0.2 (foreign body left during procedure) to 154.0 (birth trauma) problems per 10,000 discharge records.

Study authors Marlene R. Miller, M.D., M.Sc. (formerly of AHRQ and now with Johns Hopkins Children's Center), Anne Elixhauser, Ph.D., and Chunliu Zhan, M.D., Ph.D., also found that children who experienced a patient safety problem in the hospital faced a 2-18 times greater risk of death than children who did not have such a problem. They further indicated that the majority of birth trauma consisted of long bone and skull fractures, excluding collar bone. The authors noted that these infants were more likely to be black or Hispanic and to be born in institutions that had no residents on staff, had a lower percentage of beds in intensive care units, or had a lower volume of inpatient surgical procedures.

For the study, which is one of very few patient safety studies on children's hospital stays, the researchers evaluated patient safety problems involving in-hospital procedures. They used hospital discharge data to identify patient safety problems and, by definition, were only able to capture some types of problems. The types of problems captured by these measures include lacerations and perforations during elective surgery, postoperative infection, transfusion reactions, foreign bodies left during procedures, infections from procedures, misadventures in obstetrical care and anesthesia (e.g., shock during delivery or due to anesthesia), and birth trauma. According to the study authors, the total number of patient safety problems would have been much greater if medication errors could have been included in the study.

Researchers applied preliminary Patient Safety Indicators including postoperative infections and blood transfusion reactions to the Kids' Inpatient Database (KID), a compilation of data such as hospital stays, mortality rates, and charges from 22 States collected as part of AHRQ's Healthcare Cost and Utilization Project (HCUP) database. HCUP covers approximately 3.8 million hospital discharge records for children under 19 years of age and can be used to generate national estimates. The preliminary PSIs have been further refined and released publicly by AHRQ as internal screening tools for hospitals and hospital systems and medical groups to identify quality improvement opportunities.

Details are in "Patient safety events during pediatric hospitalization," by Drs. Miller, Elixhauser, and Zhan, in the June 2003 issue of Pediatrics 111, pp. 1358-1366.

Reprints (AHRQ Publication No. 03-R042) are available from the AHRQ Publications Clearinghouse.

Editor's Note: Select AHRQ's Patient Safety Indicators for PSI information and Healthcare Cost and Utilization Project for more information on HCUP and the KID.

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