Incident severity in children and young patients versus adults in intensive care: a nationwide cross-sectional analysis of spontaneously reported adverse events in Japan
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Safety incidents in intensive care can progress rapidly to permanent disability or death, and children are considered vulnerable to medication- and device-related events. Whether age itself is associated with incident severity, independent of care setting and incident type, remains unclear. We examined this question in a nationwide sample of Japanese intensive-care incident reports. Methods We analyzed publicly available adverse-event reports submitted to the Japan Council for Quality Health Care, 2013–2024, from neonatal, general, and cardiac intensive care units (NICU, ICU, CCU). Severe outcome was defined as death, or a high or low likelihood of residual disability accompanied by intensive treatment, derived from recorded harm and treatment grades. A NICU-excluded ICU/CCU subcohort served as a PICU-equivalent proxy. Modified Poisson models estimated relative risks (RR) for ages 0–19 versus 20–59 years, adding care setting, incident category, and the full covariate set sequentially. Pediatric death-associated reports underwent a structured review of apparent incident attribution. Results Of 54310 reports, 2835 occurred in these settings, and 2822 with a known age group were analyzed. Pediatric reports were concentrated in the NICU (431/688, 63%) and involved drain/tube-related (250/688, 36%) or medication-related (127/688, 18%) incidents, whereas adult reports were mainly ICU-based (444/491, 90%) and treatment/procedure-related (196/491, 40%). Crude severe-outcome rates (26% vs 38%) and reports recording death as the harm grade (4.8% vs 14%) were lower in children than in adults. The pediatric RR for a severe outcome was 0.71 (95% CI 0.59–0.84) in the crude analysis and 1.07 (0.87–1.30) after full adjustment; corresponding values in the NICU-excluded subcohort were 0.93 (0.76–1.15) and 1.08 (0.87–1.33). Of 33 pediatric death-associated reports, 8 were classified as having a definite or probable incident contribution. Conclusions The lower crude severity of pediatric reports was largely explained by NICU-predominant case-mix rather than by a protective association with young age. After adjustment, age was not independently associated with severe outcome, and PICU-equivalent reports showed no clearly lower severity risk than adult reports. Pediatric intensive-care safety should be prioritized by care setting, treatment intensity, and incident type rather than by age alone.
Source: Research Square
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7204573137