REMI 1929E. Outcome of Adverse Events and Medical Errors in the Intensive Care Unit: Systematic Review

[Versión en español]

Original article: Outcome of Adverse Events and Medical Errors in the Intensive Care Unit: A Systematic Review and Meta-analysis.Ahmed AH, Giri J, Kashyap R, Singh B, Dong Y, Kilickaya O, Erwin PJ, Murad MH, Pickering BW. Am J Med Qual 2013. [Summary] [Related articles]

   

Introduction: The current incidence of adverse events (AE) in the ICU is not clear, nor the extent to which these errors affect mortality or length of stay in the ICU. In this study, the authors conducted a systematic review and meta-analysis to examine the effects of AE on mortality and ICU and hospital lengths of stay among ICU patients.

      

Summary: Potential studies were identified in 4 large databases using keywords like "iatrogenic disease", "medical errors", "mistake", "error", "missed", "unintended" or "near-miss" and "intensive care units", "burn units", "coronary care units" and "respiratory care units". 902 articles were retrieved between 1990 and 2013, and 12 met the inclusion criteria, and 10 of them were included in quantitative analysis. Quality of the studies ranged from very low to high. The overall incidence of AE ranged from 15 to 51% (average 32%). Patients with one or more AE had a nonsignificant trend toward increased mortality, using a random effects model. The trend was significant in a fixed effect model (OR 1.5, 95% CI 1.3 to 1.8), but with considerable heterogeneity (I2 67%) that precludes the use of this model. The average lenght of stay was higher in AE patients, both in hospital (mean difference 8.9 days, 95% CI 3.3 -14.7) and ICU (mean difference 6.8 days; 95% CI 0.2 to 13.4).

      

Coments: This is the first meta-analysis to provide evidence on the influence of AE in critically ill patient outcomes and has been faced with problems such as poor quality of the available evidence and risk of bias (which could not be assessed). Thus, it has not succeeded in establishing a close relationship between adverse events and mortality as expected. The authors consider that the most serious AE may be undereported in the studies analyzed. The frequency of AE also depends on how these are defined and the detection method used. Therefore, studies comparing AE and doing quantitative analysis are difficult. The slow introduction of a definite taxonomy also complicates to adequately perform a comprehensive review of studies on AE with sufficient assurance that they included all relevant articles. However, this review provides sufficient evidence that AE are common in ICU and increase the ICU and hospital lengths of stay.

      

Ramón Díaz-Alersi

Hospital U. Puerto Real, Cádiz.

© REMI, http://medicina-intensiva.com. January 2014
 
Links:

1. SEMICYUC. Incidentes y eventos adversos en medicina intensiva. Seguridad y riesgo en el enfermo crítico. SYREC 2007. Madrid: Ministerio de Sanidad, Política Social e Igualdad; 2009. [PDF] [REMI]

PubMed Search: 

• Plain Text: clinical trials on adverse event and ICU
• Syntax: (medical errors OR iatrogenic disease) AND critical care unit AND clinical trial
• [Results]