Table 2. Outcomes of Expert Review.
| Medical | Trauma | Total | |
|---|---|---|---|
| Global Quality of Carea | (n = 239) | (n = 43) | (n = 282) |
| Poor | 55(23.0%) | 2(4.7%) | 57(20.2%) |
| Fair | 166(69.5%) | 30(69.8%) | 196(69.5%) |
| Good | 18(7.5%) | 11(25.6%) | 29(10.3%) |
| Avoidability of Death | (n = 21) | (n = 9) | (n = 30) |
| Not Avoidable | 6(28.6%) | 7(77.8%) | 13(43.3%) |
| Potentially Avoidable | 12(57.1%) | 2(22.2%) | 14(46.7%) |
| Avoidable | 3(14.3%) | 0(0.0%) | 3(10.0%) |
| Avoidability of PICU | (n = 218) | (n = 34) | (n = 252) |
| Not Avoidable | 161(73.9%) | 30(88.2%) | 191(75.8%) |
| Potentially Avoidable | 52(23.9%) | 4(11.8%) | 56(22.2%) |
| Avoidable | 5(2.3%) | 0(0.0%) | 5(2.0%) |
| Avoidability of Severity | (n = 218) | (n = 34) | (n = 252) |
| Not Avoidable | 49(22.5%) | 18(52.9%) | 67(26.6%) |
| Potentially Avoidable | 155(71.1%) | 15(44.1%) | 170(67.5%) |
| Avoidable | 14(6.4%) | 1(2.9%) | 15(6.0%) |
| System Issuesb | (n = 239) | (n = 43) | (n = 282) |
| No | 36(15.1%) | 36(83.7%) | 72(25.5%) |
| Possibly | 72(30.1%) | 3(7.0%) | 75(26.6%) |
| Yes | 131(54.8%) | 4(9.3%) | 135(47.9%) |
| Number of Modifiable Factorsc median (range; IQR) | |||
| Major Impact | 1 (0–16; 0–3) | 0 (0–8; 0–1) | 1 (0–16; 0–3) |
| Moderate Impact | 6 (0–19; 4–10) | 5 (0–13; 3–8) | 6 (0–19; 3–9) |
PICU paediatric intensive care unit; IQR inter quartile range
a grading of quality of care was performed relative to the expectations of reviewers: poor—health care which was clearly below the average expectations of the facility/health care provider (HCP); fair–health care of an average level expected of the facility/HCP; good–health care at an excellent level above average expectations
b System Issues—defined as potential healthcare interventions prior to the acute episode which could have had a positive impact on the health of the child prior to the acute critical illness. (e.g. missing long term deterioration at a prior consultation or inadequate follow up of a high risk baby)
c grading of Modifiable Factors: major (clear negative impact on the outcome for the patient), moderate (minimal negative impact on the outcome but likely caused some morbidity and/or extended the illness duration) (e.g. failure to administer a fluid bolus in a shocked child would be a major MF, delay in administration of antibiotics to a child with respiratory distress (of unclear aetiology) a moderate MF)
(a total of 3212 modifiable factors were identified for the entire cohort (comprising 477 (14.95) major, 1826 (56.9%) moderate, 44 (1.4%) near miss, 290 (9.0%) no defined impact and 575 (17.9%) unknown impact modifiable factors)