Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study)

T. Engelhardt, D. Ayansina, G. T. Bell, V. Oshan, J. S. Rutherford, N. S. Morton (Corresponding Author), APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network

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The anaesthesia practice in children observational trial of 31,127 patients in 261 European hospitals revealed a high (5.2%) incidence of severe critical events in the peri-operative period and wide variability in practice. A sub-analysis of the UK data was undertaken to investigate differences compared with the non-UK cohort in the incidence and nature of peri-operative severe critical events and to attempt to identify areas for quality improvement. In the UK cohort of 7040 paediatric patients from 43 hospitals, the overall incidence of perioperative severe critical events was lower than in the non-UK cohort (3.3%, 95%CI: 2.9–3.8 vs. 5.8%, 95%CI: 5.5– 6.1, RR 0.57, p < 0.001). There was a lower rate of bronchospasm (RR 0.22, 95%CI: 0.14–0.33; p < 0.001), stridor (RR 0.42, 95%CI: 0.28–0.65; p < 0.001) and cardiovascular instability (RR 0.69, 95%CI: 0.55–0.86; p = 0.001) than in the non-UK cohort. The proportion of sicker patients where less experienced teams were managing care was lower in the UK than in the non-UK cohort (10.4% vs. 20.4% of the ASA physical status 3 and 9% vs. 12.9% of the ASA physical status 4 patients). Differences in work-load between centres did not affect the incidence and outcomes of severe critical events when stratified for age and ASA physical status. The lower incidence of cardiovascular and respiratory complications could be partly attributed to more experienced dedicated paediatric anaesthesia providers managing the higher risk patients in the UK. Areas for quality improvement include: standardisation of serious critical event definitions; increased reporting; development of evidence-based protocols for management of serious critical events; development and rational use of paediatric peri-operative risk assessment scores; implementation of current best practice in provision of competent paediatric anaesthesia services in Europe; development of specific training in the management of severe peri-operative critical events; and implementation of systems for ensuring maintenance of skills.
Original languageEnglish
Pages (from-to)300-311
Number of pages12
Issue number3
Early online date10 Dec 2018
Publication statusPublished - Mar 2019

Bibliographical note

APRICOT was registered with (NCT01878760). The funding source (ESA) provided the infrastructure for the trial. The UK national study
coordinating investigator (NM), liaised with the local investigators regarding their ethics submission process and the inclusion period, and monitored the data entry and cleaning. A UK-wide waiver for individual patient/family consent was granted and Caldicott guardian approval was given for data management, anonymisation procedures and data security. Authors NM, TE and DA had full access to all UK data in the study and had the final responsibility for the decision to submit the manuscript. The ESA principal investigators approved the manuscript content before submission.


  • critical incident reporting
  • paediatric anaesthesia
  • quality improvement
  • UK
  • RISK


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