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Hypoglycemia Adverse Events in PICUs and Cardiac ICUs: Differentiating Preventable and Nonpreventable Events*

Shea, Paul L. MD1,2; Spaeder, Michael C. MD3,4; Sayal, Puneet MD, MSPH5; Jacobs, Brian R. MD3,4; Stockwell, David C. MD, MBA3,4

Pediatric Critical Care Medicine: October 2013 - Volume 14 - Issue 8 - p 741–746
doi: 10.1097/PCC.0b013e3182975f0f
Feature Articles

Objectives: To describe the use of an adverse event detection system to identify, characterize, and categorize preventable versus nonpreventable hypoglycemia AEs in PICUs and cardiac ICUs.

Design: Retrospective observational study.

Setting: PICU and cardiac ICU of a tertiary pediatric hospital.

Subjects: All hypoglycemia triggers generated over a 3-year period.

Interventions: All hypoglycemia triggers generated via an electronic health record-driven surveillance system were investigated to determine if they represented a true adverse event and if that event was preventable or nonpreventable. Clinical and demographic variables were analyzed to identify characteristics of patients who developed a preventable or nonpreventable hypoglycemia adverse event.

Measurements and Main Results: There were 197 hypoglycemia adverse events in 90 patients. Thirty percent of the adverse events in the PICU and 36% of the adverse events in the cardiac ICU were characterized as preventable. Of the adverse events, 118 (59.9%) necessitated an intravenous dextrose bolus. No adverse events were associated with reporting of symptoms of hypoglycemia including apnea, altered mental status, or seizures. Events were more likely to be preventable (p < 0.001) if the patient was receiving only parenteral sources of nutrition (intravenous fluids or total parenteral nutrition). Controlling for weekends and holidays, adverse events associated with sole parenteral nutrition source had an increased odds ratio of 9.5 (95% confidence interval: 2.8–31.9) of being preventable. Stratifying by ICU, cardiac ICU events occurring on a weekend or holiday were more likely to be preventable (p = 0.001). Stratifying by unit and controlling for parenteral nutrition source, adverse events in the cardiac ICU occurring on weekends or holidays had an increased odds ratio of 11.6 (95% confidence interval: 2.7–50.2) of being preventable.

Conclusions: Preventable hypoglycemia adverse events are associated with patients receiving sole parenteral sources of nutrition in both the PICU and cardiac ICU. In the cardiac ICU, there is an association between weekend and holiday time periods and the development of preventable hypoglycemia adverse events.

1Department of Pediatrics, Section of Critical Care, St Christopher’s Hospital for Children, Philadelphia, PA.

2Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA.

3Department of Critical Care Medicine, Children’s National Medical Center, Washington, DC.

4Department of Pediatrics, The George Washington University School of Medicine, Washington, DC.

5Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.

* See also p. 819.

This work was performed at Children’s National Medical Center, Washington, DC.

Dr. Stockwell received a research grant from the Cerner Corporation, Kansas City, MO. Drs. Stockwell, Shea, Spaeder, Sayal, Jacobs, and Stockwell received funding from the Cerner Corporation.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies