The impact of procedural sedation on diagnostic errors in pediatric echocardiography

Kenan W.D. Stern, Kimberlee Gauvreau, Tal Geva, Oscar J. Benavidez

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

BACKGROUND: Infants and young children frequently have difficulty remaining still for an echocardiographic examination, potentially leading to poor study quality, increasing the likelihood of diagnostic errors. Sedation is believed to improve echocardiographic quality, but its effectiveness has not been demonstrated. The aim of this study was to test the hypothesis that sedation would improve study quality and reduce diagnostic errors.

METHODS: Outpatient echocardiograms from children aged ≤36 months obtained from January 2008 to June 2009 were examined. Variables related to image quality, report completeness, and sedation use were collected. Diagnostic errors were identified and categorized. Multivariate analysis identified the odds ratios (OR) and 95% confidence intervals (CI) for risk factors for potentially preventable diagnostic errors and the impact of sedation on these errors.

RESULTS: Among 2,003 echocardiographic examinations, sedation was used in 498 (25%). The overall diagnostic error rate was 6.5%. Most errors (66%) were potentially preventable. Multivariate analysis identified the following risk factors for potentially preventable errors: precardiac procedure (OR, 2.19; 95% CI, 1.05-4.59; P = .04), moderate anatomic complexity (OR, 3.91; 95% CI, 2.25-6.81; P < .001), and high anatomic complexity (OR, 8.36; 95% CI, 3.57-19.6; P < .001). Sedation was independently associated with lower odds of potentially preventable diagnostic errors (OR, 0.47; 95% CI, 0.27-0.80; P = .006). Echocardiographic examinations with sedation had fewer image quality concerns (22% vs 60%) and fewer incomplete reports (3% vs 20%) (P < .001).

CONCLUSIONS: Most echocardiographic diagnostic errors among infants and young children are potentially preventable. Sedation is associated with a lower likelihood of these diagnostic errors, fewer imaging quality concerns, and fewer incomplete reports.

Original languageEnglish (US)
Pages (from-to)949-955
Number of pages7
JournalJournal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
Volume27
Issue number9
DOIs
StatePublished - Sep 1 2014
Externally publishedYes

Fingerprint

Diagnostic Errors
Echocardiography
Pediatrics
Odds Ratio
Confidence Intervals
Multivariate Analysis
Outpatients

Keywords

  • Diagnostic errors
  • Echocardiography
  • Pediatric and congenital heart disease
  • Procedural sedation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

The impact of procedural sedation on diagnostic errors in pediatric echocardiography. / Stern, Kenan W.D.; Gauvreau, Kimberlee; Geva, Tal; Benavidez, Oscar J.

In: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, Vol. 27, No. 9, 01.09.2014, p. 949-955.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Infants and young children frequently have difficulty remaining still for an echocardiographic examination, potentially leading to poor study quality, increasing the likelihood of diagnostic errors. Sedation is believed to improve echocardiographic quality, but its effectiveness has not been demonstrated. The aim of this study was to test the hypothesis that sedation would improve study quality and reduce diagnostic errors.METHODS: Outpatient echocardiograms from children aged ≤36 months obtained from January 2008 to June 2009 were examined. Variables related to image quality, report completeness, and sedation use were collected. Diagnostic errors were identified and categorized. Multivariate analysis identified the odds ratios (OR) and 95{\%} confidence intervals (CI) for risk factors for potentially preventable diagnostic errors and the impact of sedation on these errors.RESULTS: Among 2,003 echocardiographic examinations, sedation was used in 498 (25{\%}). The overall diagnostic error rate was 6.5{\%}. Most errors (66{\%}) were potentially preventable. Multivariate analysis identified the following risk factors for potentially preventable errors: precardiac procedure (OR, 2.19; 95{\%} CI, 1.05-4.59; P = .04), moderate anatomic complexity (OR, 3.91; 95{\%} CI, 2.25-6.81; P < .001), and high anatomic complexity (OR, 8.36; 95{\%} CI, 3.57-19.6; P < .001). Sedation was independently associated with lower odds of potentially preventable diagnostic errors (OR, 0.47; 95{\%} CI, 0.27-0.80; P = .006). Echocardiographic examinations with sedation had fewer image quality concerns (22{\%} vs 60{\%}) and fewer incomplete reports (3{\%} vs 20{\%}) (P < .001).CONCLUSIONS: Most echocardiographic diagnostic errors among infants and young children are potentially preventable. Sedation is associated with a lower likelihood of these diagnostic errors, fewer imaging quality concerns, and fewer incomplete reports.",
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N2 - BACKGROUND: Infants and young children frequently have difficulty remaining still for an echocardiographic examination, potentially leading to poor study quality, increasing the likelihood of diagnostic errors. Sedation is believed to improve echocardiographic quality, but its effectiveness has not been demonstrated. The aim of this study was to test the hypothesis that sedation would improve study quality and reduce diagnostic errors.METHODS: Outpatient echocardiograms from children aged ≤36 months obtained from January 2008 to June 2009 were examined. Variables related to image quality, report completeness, and sedation use were collected. Diagnostic errors were identified and categorized. Multivariate analysis identified the odds ratios (OR) and 95% confidence intervals (CI) for risk factors for potentially preventable diagnostic errors and the impact of sedation on these errors.RESULTS: Among 2,003 echocardiographic examinations, sedation was used in 498 (25%). The overall diagnostic error rate was 6.5%. Most errors (66%) were potentially preventable. Multivariate analysis identified the following risk factors for potentially preventable errors: precardiac procedure (OR, 2.19; 95% CI, 1.05-4.59; P = .04), moderate anatomic complexity (OR, 3.91; 95% CI, 2.25-6.81; P < .001), and high anatomic complexity (OR, 8.36; 95% CI, 3.57-19.6; P < .001). Sedation was independently associated with lower odds of potentially preventable diagnostic errors (OR, 0.47; 95% CI, 0.27-0.80; P = .006). Echocardiographic examinations with sedation had fewer image quality concerns (22% vs 60%) and fewer incomplete reports (3% vs 20%) (P < .001).CONCLUSIONS: Most echocardiographic diagnostic errors among infants and young children are potentially preventable. Sedation is associated with a lower likelihood of these diagnostic errors, fewer imaging quality concerns, and fewer incomplete reports.

AB - BACKGROUND: Infants and young children frequently have difficulty remaining still for an echocardiographic examination, potentially leading to poor study quality, increasing the likelihood of diagnostic errors. Sedation is believed to improve echocardiographic quality, but its effectiveness has not been demonstrated. The aim of this study was to test the hypothesis that sedation would improve study quality and reduce diagnostic errors.METHODS: Outpatient echocardiograms from children aged ≤36 months obtained from January 2008 to June 2009 were examined. Variables related to image quality, report completeness, and sedation use were collected. Diagnostic errors were identified and categorized. Multivariate analysis identified the odds ratios (OR) and 95% confidence intervals (CI) for risk factors for potentially preventable diagnostic errors and the impact of sedation on these errors.RESULTS: Among 2,003 echocardiographic examinations, sedation was used in 498 (25%). The overall diagnostic error rate was 6.5%. Most errors (66%) were potentially preventable. Multivariate analysis identified the following risk factors for potentially preventable errors: precardiac procedure (OR, 2.19; 95% CI, 1.05-4.59; P = .04), moderate anatomic complexity (OR, 3.91; 95% CI, 2.25-6.81; P < .001), and high anatomic complexity (OR, 8.36; 95% CI, 3.57-19.6; P < .001). Sedation was independently associated with lower odds of potentially preventable diagnostic errors (OR, 0.47; 95% CI, 0.27-0.80; P = .006). Echocardiographic examinations with sedation had fewer image quality concerns (22% vs 60%) and fewer incomplete reports (3% vs 20%) (P < .001).CONCLUSIONS: Most echocardiographic diagnostic errors among infants and young children are potentially preventable. Sedation is associated with a lower likelihood of these diagnostic errors, fewer imaging quality concerns, and fewer incomplete reports.

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