October 12, 2012

Chronic Conditions in Kids Raise the Risk of Hospital Medical Error

About 44 in 100 pediatric inpatients suffer from chronic illnesses such as asthma, diabetes, epilepsy and cancer, according to the journal Pediatrics. And these sick kids are more likely to experience a medical error during the course of their treatment than patients who are seen for acute conditions.

In the study, medical errors were defined as abnormal complications to a specific medical procedure, adverse reactions to medications, infections and bedsores. But it is unclear how severe the medical mistakes were or if they caused significant or long-term harm.

Logic tells you that the increase in probability of a medical error is higher in someone who’s chronically ill—after all, the longer someone’s hospitalized and the worse his or her condition is, the higher the chances of complications from it. Duration and difficulty make treatment more challenging and exposure to infectious agents more likely.

The study involved 38 states in the 2006 Kids’ Inpatient Database (KID) to determine medical error rates. As reported on AboutLawsuits.com, not only was the medical error rate higher per 100 hospital discharges in children with chronic illnesses, but it was also higher per 1,000 inpatient days in children with chronic conditions.

In the 2006 KID:


  • more than 22 in 100 pediatric inpatients had one chronic condition;

  • nearly 10 in 100 had two chronic conditions;

  • 12 in 100 had more than three chronic conditions.


The researchers said that as many as 43 in 100 U.S. children have at least one chronic health condition, and almost 20 in 100 have two. These patients represent an increasing proportion of pediatric hospitalization, and account for the majority of noninjury hospital admissions. Children with special medical needs also are more susceptible to errors in emergency situations.

A report by the Institute of Medicine (IOM) found that nearly 98,000 people die in hospitals each year from a medical error that could have been prevented.

The message of the Pediatrics study was simple: The more chronic conditions a child suffers, the greater the likelihood that an error will occur when they are in the hospital. And the greater the need for parents to be strong patient advocates. To learn how, see our newsletter, “Protecting a Loved One in the Hospital.”

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May 10, 2012

Teens Who Develop Diabetes Have a Stark Future

Youth often confers health benefits not available to adults. One example is metabolism—when you’re young, you burn calories faster than when you’ve stopped growing and age (among other factors) imposes a more sedentary existence. Another example is bone regeneration—younger folks build bone better and faster than their elders, and generally are not at risk of osteoporosis, a degenerative bone disorder.

But a new study signals that one dread disorder—diabetes—is as ominous for youngsters as it is for adults. A study and companion editorial in the New England Journal of Medicine made clear that if a teenager develops Type 2 diabetes, he or she will struggle for life to control it.

The problem is obesity. Thanks to poor diet and insufficient exercise, too many teenagers are overweight, concluded the largest federally funded study ever to examine how to treat diabetes in teens. (Earlier studies primarily focused on adults.)

Most diabetes drugs aren't approved for youths. So the key for kids is to prevent the disease, not to treat it.

As a story in the Associated Press pointed out, in earlier generations, doctors seldom saw children with Type 2 diabetes. (Type 1 diabetes, formerly called “juvenile diabetes,” presents earlier, and is attributed to both genetic risk and external factors, such as diet or an infection.)

One-third of U.S. children and teens are overweight or obese. They are at higher risk of developing Type 2 diabetes, in which the body either fails to make enough insulin or to use it efficiently to metabolize sugar from food.

Treatment for Type 2 diabetes usually is metformin, a drug to lower blood sugar. If that doesn’t control the problem, other drugs and daily insulin shots may be required. The risks of long-term blood sugar problems include blindness, nerve damage, kidney failure, limb amputation, heart attack and stroke.

Read more about diabetes and its standards of care here.

The study tested how to manage blood sugar in teens newly diagnosed with diabetes. Half of the nearly 700 subjects failed within a few years; 1 in 5 suffered serious complications.

The study subjects had their blood sugar normalized with metformin, then were given either metformin alone, metformin plus diet and exercise counseling or metformin plus a second drug, Avandia. After nearly four years, half of the metformin-only group failed to maintain blood sugar control. The group on two drugs did a little better, but not much different from those in the lifestyle group.

Because Avandia has been linked to a higher risk of heart attacks in adults (which became known after the study began), it’s not recommended for teens.

The NEJM editorial, by Dr. David Allen, called the study’s message “stark”: “[T]omorrow and beyond, public-policy approaches — sufficient economic incentives to produce and purchase healthy foods and to build safe environments that require physical movement — and not simply the prescription of more and better pills will be necessary to stem the epidemic of Type 2 diabetes and its associated morbidity.”

Yes, the problem is social. But it’s also individual. Parents must establish healthful eating habits early in life, and ensure that their children exercise their bodies as well as their minds. Those are the earliest, easiest and best interventions to prevent the insidious disease that robs so many people of so much, and many of them too soon.

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