Pediatric Weight Errors and Resultant Medication Dosing Errors in the Emergency Department

A retrospective study of 79,000 ED encounters at a children’s hospital and two general hospitals. The intent of the study was to characterize the frequency of weight errors and to determine of the children’s hospital was any better at correcting errors than the general hospitals. The findings were that weight errors were uncommon (0.63% of all weights, as defined by the weight being a new extreme value on the growth chart) in the 3 EDs, but they led to identifiable weight-based medication-dosing errors with the potential to cause harm. The rates of error where similar across hospitals, and it looked like the children’s hospital was slightly better at intercepting errors once they were committed. Common weight errors included the weight in pounds being substituted for the weight in kilograms and decimal placement errors.

Hirata 2017 (Link) | PubMed 28976456 | Author Search

Trends in Anthropometric Measures Among US Children 6 to 23 Months, 1976–2014

Aimed to describe trends in length-for-age, weight-for-age, weight-for-length, and early childhood weight gain among US children aged 6 to 23 months from NHANES data ranging from 1976 to 2014. Between 1976–1980 and 2011–2014, there were no significant trends in low or high weight-for-age and weight-for-length, whereas the percent with high length-for-age decreased (5.5% to 3.7%). Non-Hispanic black children gained more weight between birth and survey participation in 2011–2014 versus 1988–1994.

Akinbami 2017 (Pediatrics) | PubMed 28213608 | Author Search

Prescription Errors before and after Introduction of Electronic Medication Alert System in a Pediatric Emergency Department

The objective of this was to compare prescription error rates before and after introduction of computerized provider order entry on a pediatric emergency department. Error assessment was limited to errors with potential to cause life-threatening injury, failure of therapy, or an adverse drug effect. 29.6% of prescriptions generated an alert, with an almost 90% false-positive rate. 7,268 medication orders before and 7,292 after were compared, showing a significant reduction in the errors per 100 prescriptions (10.4 before vs. 7.3 after; absolute risk reduction = 3.1, 95% confidence interval [CI] = 2.2 to 4.0)

Sethuraman 2015 (Link) | PubMed 25998704 | Author Search

Diagnostic Errors in Primary Care Pediatrics: Project RedDE

This study examined the prevalence of three diagnostic errors or missed opportunities to diagnose in pediatric primary care practices (adolescent depression, elevated blood pressure, and sexually-transmitted infection lab results). They found that these errors were common. Providers did not follow up abnormal STI laboratory values for 11% of patients and did not address adolescent depression in 62% of visits. Providers did not document recognition of an elevated BP in 51% of patients with elevated BP

Rinke 2017 (Acad Pediatrics) | PubMed 28804050 | Author Search

Growth Tracking in Severely Obese or Underweight Children

Report on experience using a body-mass index chart that may be better suited for plotting children at the extremes of the growth spectrum. This growth chart uses a “modified z score,” proposed by the CDC, which expresses variations from the median in terms of a unit equal to one half the difference between 0 and +2 z scores (for measures above the mean) and one half the difference between 0 and -2 z scores (for measures below the mean) for any given age and gender.

If one uses modified z score as the y-axis against age, ordinary BMI changes fall along a curve that is much close to a straight line, so outliers should be easier to spot in this circumstance.

Authors illustrate the advantages of using an age-vs-BMI chart with modified z-score isobars over the standard CDC 2000 charts and over the modified charts showing the percentage of the 95th percentile of BMI.

Chambers 2017 (Pediatrics) | PubMed 29114063 | Author Search

Validity of the WHO Cutoffs for Biologically Implausible values of Weight, Height, and BMI in Children and Adolescents in NHANES from 1999 through 2012

This analysis of data on 26,480 children and adolescents taken as part of the NHANES study from 1999–2000 through 2011–2012 showed that the overall prevalence of children with biologically implausible body measurements (determined commonly accepted rules involving modified z scores) was 0.9%. Most of these were high values rather than low. Further analysis that correlated these BIVs with other body measurements suggested that the majority of these seemingly anomalous values were accurate. Using these methods to exclude BIVs tends to underestimate the prevalence of obesity in these data.

Am J Clin Nutr. 2015 Nov; 102(5): 1000–1006.
Freedman 2015 (Link) | PubMed 26377160 | Author Search

Tenfold Medication Errors: 5 Years’ Experience at a University-Affiliated Pediatric Hospital

A study of pediatric inpatient safety reports. From the abstract: “From 6643 medication-related safety reports, 252 10-fold medication errors were identified at a mean reporting rate of 0.062 per 100 total patient days. Morphine was the most frequently reported medication, and opioids were the most frequently reported drug class. Twenty-two reports described patient harm. Intravenous formulations, paper ordering, and drug-delivery pumps were frequent error enablers. Errors of dose calculation, documentation of decimal points, and confusion with zeroes were frequent contributing causes to 10-fold medication error.”

Doherty 2012 (Pediatrics) | PubMed 22473367 | Author Search