Methodology
The researchers conducted a retrospective methodological study to develop and evaluate the possibility of using the German Pediatric Trigger Tool (PAED‑TT‑GER) to identify adverse events, assess its applicability in everyday practice, and ensure reliable agreement between reviewers.
They examined 200 electronic medical records of patients under 18 years of age (average age — 4 years; 48.5 % were girls) who received treatment in the pediatric cardiology department of one of the German hospitals (between August 2020 and October 2023), had been hospitalized for at least 24 hours, and were discharged at least 30 days before the records were reviewed.
The researchers developed and evaluated PAED‑TT‑GER using a multi‑stage process that included a literature review, expert consensus involving healthcare professionals, and pilot testing. A qualified pediatrician reviewed the medical records, and cases with positive triggers were subject to additional review by a doctor. Inter‑rater reliability was initially assessed on a subsample of 27 records by two trained reviewers.
Results
The tool identified 472 triggers across patient records, with a mean of 2.36 triggers per admission. The most frequent triggers were hematomas and vascular access complications, circulatory abnormalities, and respiratory abnormalities.
A total of 45 AEs were confirmed in 42 patients, corresponding to a 21% AE prevalence. Of them, 15.6% were rated as probably to certainly preventable.
Among identified AEs, 53.3% caused temporary harm requiring intervention, 42.2% caused temporary harm requiring prolonged hospitalization, and 4.4% resulted in permanent harm.
Researchers reported interrater reliability as an intraclass correlation coefficient of 0.794 for the count of triggers per case (P < .001). On average, 60.4% of all reported triggers were the same for both reviewers.
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