• Carin W Verlaat, Marieke Zegers, Richard Klein, Dick van Waardenburg, Jan Willem Kuiper, Maaike Riedijk, Martin Kneyber, Brigitte Timmers, Marc van Heerde, Jan A Hazelzet, Johannes van der Hoeven, Joris Lemson, and PICE registry (Pediatric Intensive Care Evaluation)/SKIC (Dutch Collaborative PICU Research Network).
• Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.
• Pediatr Crit Care Me. 2023 Jan 1; 24 (1): 4164-16.

ObjectivesSome patients with a low predicted mortality risk in the PICU die. The contribution of adverse events to mortality in this group is unknown. The aim of this study was to estimate the occurrence of adverse events in low-risk nonsurvivors (LN), compared with low-risk survivors (LS) and high-risk PICU survivors and nonsurvivors, and the contribution of adverse events to mortality.DesignCase control study. Admissions were selected from the national Dutch PICU registry, containing 53,789 PICU admissions between 2006 and 2017, in seven PICUs. PICU admissions were stratified into four groups, based on mortality risk (low/high) and outcome (death/survival). Random samples were selected from the four groups. Cases were "LN." Control groups were as follows: "LS," "high-risk nonsurvivors" (HN), and "high-risk survivors" (HS). Adverse events were identified using the validated trigger tool method.SettingPatient chart review study.PatientsChildren admitted to the PICU with either a low predicted mortality risk (< 1%) or high predicted mortality risk (≥ 30%).InterventionsNone.Measurements And Main ResultsIn total, 419 patients were included (102 LN, 107 LS, 104 HN, and 106 HS). LN had more complex chronic conditions (93.1%) than LS (72.9%; p < 0.01), HN (49.0%; p < 0.001), and HS (48.1%; p < 0.001). The occurrence of adverse events in LN (76.5%) was higher than in LS (13.1%) and HN (47.1%) ( p < 0.001). The most frequent adverse events in LN were hospital-acquired infections and drug/fluid-related adverse events. LN suffered from more severe adverse events compared with LS and HS ( p < 0.001). In 30.4% of LN, an adverse event contributed to death. In 8.8%, this adverse event was considered preventable.ConclusionsSignificant and preventable adverse events were found in low-risk PICU nonsurvivors. 76.5% of LN had one or more adverse events. In 30.4% of LN, an adverse event contributed to mortality.Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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