Iatrogenic Pneumothorax (PDI 5) (NQF 0348)

EMeasure Name Iatrogenic Pneumothorax (PDI 5) EMeasure Id 838518AC-21B6-4979-B1B5-6D625BDAEEC0
Version number 1 Set Id F1080C43-DEAA-4597-A98A-A9688A3162EB
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Agency for Healthcare Research and Quality
Endorsed by National Quality Forum
Description Percent of medical and surgical discharges, age under 18 years, with ICD-9-CM code of iatrogenic pneumothorax in any secondary diagnosis field
Copyright
Measure scoring Ratio
Measure type Outcome
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
This indicator is intended to flag cases of pneumothorax caused by medical care, which is sustained following a procedure or due to barotraumas. Good technique when performing vascular access or thoracentesis may reduce the risk of this complication. For patients on ventilators, monitoring of pressures may also reduce the risk of this complication.
Clinical Recommendation Statement
Using 1997 Healthcare Cost and Utilization Project (HCUP) data, the National Healthcare Quality Report cited rates of iatrogenic pneumothorax in the pediatric population (less than 19 years). These analyses showed that this patient safety event occurred frequently and at rates comparable to those in adults (e.g., 0.48 per 1,000 discharges at 0 to 17 years, 0.42 at 18 to 44 years, 0.43 at 45 to 64 years, and 0.74 at 65 or more years). Other groups have analyzed rates of this indicator using the publicly available indicator definition applied to a pediatric population; this definition differs slightly from the definition proposed for this measure. In 2000, Miller et al. found iatrogenic pneumothorax occurred at a rate of 0.3 per 1,000 discharges among 0 to 18 year old children. Also, iatrogenic pneumothorax was found to result, on average, 11.6 days increased length of stay, $61,991 increased charges, and 7.5 times higher odds of in-hospital mortality (after adjusting for age, gender, expected payer, up to 30 comorbidities, and multiple hospital characteristics, including ownership, teaching status, nursing expertise, urban location, bed size, pediatric volume, coding intensity, intensive care unit [ICU] bed percentage, and surgical discharge percentage). An analysis of National Association of Children's Hospitals and Related Institutions (NACHRI) data from 1999 to 2002 showed a range of rates (risk adjusted) from 0.74 per 1,000 discharges in 2002 to 0.82 per 1,000 discharges in 1999 (i.e., a slight downward trend over time).
    
In children, procedures like central line placement, thoracentesis, or Swan-Ganz catheter placement can be technically more complex than in older patients due to their smaller anatomy (though they are more likely to be performed in a monitored setting). Also, in comparison to adults, iatrogenic pneumothoraces in neonates are primarily due to bartrauma, with the very smallest infants being at greatest risk (as shown by our preliminary empirical analyses). In an older pediatric population, while barotraumas can occur, the risks for iatrogenic pneumothoraces are more clinically similar to a adult population (e.g., at risk while receiving a central line, catheter, or undergoing thoracentesis procedures).
Improvement notation
Measurement duration
12 month(s)
Reference
Agency for Healthcare Research and Quality (AHRQ). National healthcare quality report. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2003.
Reference
Miller MR, Zhan C. Pediatric patient safety in hospitals: a national picture in 2000. Pediatrics 2004 Jun;113(6):1741-6. [23 references] PubMed
Reference
Sedman A, Harris JM 2nd, Schulz K, Schwalenstocker E, Remus D, Scanlon M, Bahl V. Relevance of the Agency for Healthcare Research and Quality Patient Safety Indicators for children's hospitals. Pediatrics 2005 Jan;115(1):135-45. [17 references] PubMed
Definition
Guidance

Table of Contents


Population criteria

Data criteria (QDS Data Elements)

Summary Calculation

Calculation is generic to all measures:



Measure set CLINICAL QUALITY MEASURE SET 2011-2012