TY - JOUR
T1 - Incidence of severe critical events in paediatric anaesthesia (APRICOT)
T2 - a prospective multicentre observational study in 261 hospitals in Europe
AU - APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network
AU - Habre, Walid
AU - Disma, Nicola
AU - Virag, Katalin
AU - Becke, Karin
AU - Hansen, Tom G.
AU - Jöhr, Martin
AU - Leva, Brigitte
AU - Morton, Neil S.
AU - Vermeulen, Petronella M.
AU - Zielinska, Marzena
AU - Boda, Krisztina
AU - Veyckemans, Francis
AU - Klimscha, Walter
AU - Konecny, Regina
AU - Luntzer, Robert
AU - Morawk-Wintersperger, Ulrike
AU - Neiger, Franz
AU - Rustemeyer, Lydia
AU - Breschan, Christian
AU - Frey, Denise
AU - Platzer, Manuela
AU - Germann, Reinhard
AU - Oeding, Joachim
AU - Stoegermüller, Birgit
AU - Ziegler, Bernhard
AU - Brotatsch, Philipp
AU - Gutmann, Anton
AU - Mausser, Gerlinde
AU - Messerer, Brigitte
AU - Toller, Wolfgang
AU - Vittinghoff, Maria
AU - Zangl, Gregor
AU - Seidel-Ahyai, Natascha
AU - Hochhold, Christoph
AU - Kroess, Ruth
AU - Paal, Peter
AU - Cnudde, Steven
AU - Coucke, Patricia
AU - Loveniers, Birgit
AU - Mitchell, John
AU - Kahn, David
AU - Pirotte, Thierry
AU - Pregardien, Caroline
AU - Veyckemans, Francis
AU - Coppens, Marc
AU - De Hert, Stefan
AU - Heyse, Björn
AU - Neckebroek, Martine
AU - Alanoglu, Zekeriyya
AU - Smith, Carolyn
N1 - Publisher Copyright:
© 2017 Elsevier Ltd
PY - 2017/5
Y1 - 2017/5
N2 - Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0–5·5) with an incidence of respiratory critical events of 3·1% (2·9–3·3). Cardiovascular instability occurred in 1·9% (1·7–2·1), with an immediate poor outcome in 5·4% (3·7–7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86–0·90; p<0·0001), medical history, and physical condition (1·60, 1·40–1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981–0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97–0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. Funding European Society of Anaesthesiology.
AB - Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0–5·5) with an incidence of respiratory critical events of 3·1% (2·9–3·3). Cardiovascular instability occurred in 1·9% (1·7–2·1), with an immediate poor outcome in 5·4% (3·7–7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86–0·90; p<0·0001), medical history, and physical condition (1·60, 1·40–1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981–0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97–0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. Funding European Society of Anaesthesiology.
UR - http://www.scopus.com/inward/record.url?scp=85016553134&partnerID=8YFLogxK
U2 - 10.1016/S2213-2600(17)30116-9
DO - 10.1016/S2213-2600(17)30116-9
M3 - Article
C2 - 28363725
AN - SCOPUS:85016553134
SN - 2213-2600
VL - 5
SP - 412
EP - 425
JO - The Lancet Respiratory Medicine
JF - The Lancet Respiratory Medicine
IS - 5
ER -