Advertisement

Quality indicators for pediatric colonoscopy: results from a multicenter consortium

Published:August 05, 2015DOI:https://doi.org/10.1016/j.gie.2015.06.028

      Background and Aims

      Currently, there are no quality measures specific to children undergoing GI endoscopy. We aimed to determine the baseline quality of pediatric colonoscopy by using the Pediatric Endoscopy Database System—Clinical Outcomes Research Initiative (PEDS-CORI), a central registry.

      Methods

      We conducted prospective data collection by using a standard computerized report generator and central registry (PEDS-CORI) to examine key quality indicators from 14 pediatric centers between January 2000 and December 2011. Specific quality indicators, including bowel preparation, ileal intubation rate, documentation of American Society of Anesthesiologists Physical Status Classification System (ASA) class, and procedure time, were compared during the study period.

      Results

      We analyzed 21,807 colonoscopy procedures performed in patients with a mean age of 11.5 ± 4.8 years. Of the 21,807 reports received during the study period, 56% did not include bowel preparation quality, and 12.7% did not include ASA classification. When bowel preparation was reported, the quality was described as excellent, good, or fair in 90.3%. The overall ileal intubation rate was 69.4%, and 15.6% reported cecal intubation only, calculated to be 85% cecum or ileum intubation. Thus, 15% of colonoscopy procedures did not report reaching the cecum or ileum. When excluding the proportion of procedures not intended to reach the ileum (31.5%), the overall ileal intubation rate increased to 84.0%. The rate of ileum examination varied from 85% to 95%, depending on procedure indication.

      Conclusions

      Colonoscopy reports from our central registry revealed significant variations and inconsistent documentation in pediatric colonoscopy. Our study identifies areas for quality improvement and highlights the need for developing accepted quality measures specific to pediatric endoscopy.

      Abbreviations:

      ASA (American Society of Anesthesiologists Physical Status Classification System), PEDS-CORI (Pediatric Endoscopy Database System-Clinical Outcomes Research Initiative)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Thakkar K.
        • El-Serag H.B.
        • Mattek N.
        • Gilger M.
        Complications of pediatric colonoscopy: a five-year multicenter experience.
        Clin Gastroenterol Hepatol. 2008; 6: 515-520
        • Logan J.R.
        • Lieberman D.A.
        The use of databases and registries to enhance colonoscopy quality.
        Gastrointest Endosc Clin N Am. 2010; 20: 717-734
        • Gilger M.A.
        • Gold B.D.
        Pediatric endoscopy: new information from the PEDS-CORI project.
        Curr Gastroenterol Rep. 2005; 7: 234-239
        • Faigel D.O.
        • Pike I.M.
        • Baron T.H.
        • et al.
        Quality indicators for gastrointestinal endoscopic procedures: an introduction.
        Am J Gastroenterol. 2006; 101: 866-872
        • Lightdale J.R.
        • Acosta R.
        • Shergill A.K.
        • et al.
        Modifications in endoscopic practice for pediatric patients.
        Gastrointest Endosc. 2014; 79: 699-710
        • Prause G.
        • Ratzenhofer-Comenda B.
        • Pierer G.
        • et al.
        Can ASA grade or Goldman's cardiac risk index predict peri-operative mortality? A study of 16,227 patients.
        Anaesthesia. 1997; 52: 203-206
        • Sharma V.K.
        • Nguyen C.C.
        • Crowell M.D.
        • et al.
        A national study of cardiopulmonary unplanned events after GI endoscopy.
        Gastrointest Endosc. 2007; 66: 27-34
        • Thakkar K.
        • El-Serag H.B.
        • Mattek N.
        • et al.
        Complications of pediatric EGD: a 4-year experience in PEDS-CORI.
        Gastrointest Endosc. 2007; 65: 213-221
        • Hassall E.
        • Barclay G.N.
        • Ament M.E.
        Colonoscopy in childhood.
        Pediatrics. 1984; 73: 594-599
        • Kawamitsu T.
        • Nagashima K.
        • Tsuchiya H.
        • et al.
        Pediatric total colonoscopy.
        J Pediatr Surg. 1989; 24: 371-374
        • Mamula P.
        • Markowitz J.E.
        • Neiswender K.
        • et al.
        Success rate and duration of paediatric outpatient colonoscopy.
        Dig Liver Dis. 2005; 37: 877-881
        • Sawczenko A.
        • Sandhu B.K.
        Presenting features of inflammatory bowel disease in Great Britain and Ireland.
        Arch Dis Child. 2003; 88: 995-1000
      1. Inflammatory bowel disease in children and adolescents: recommendations for diagnosis—the Porto criteria.
        J Pediatr Gastroenterol Nutr. 2005; 41: 1-7
        • Geboes K.
        • Ectors N.
        • D'Haens G.
        • et al.
        Is ileoscopy with biopsy worthwhile in patients presenting with symptoms of inflammatory bowel disease?.
        Am J Gastroenterol. 1998; 93: 201-206
        • Barclay R.L.
        • Vicari J.J.
        • Doughty A.S.
        • et al.
        Colonoscopic withdrawal times and adenoma detection during screening colonoscopy.
        N Engl J Med. 2006; 355: 2533-2541
        • Kjaergard H.
        • Nordkild P.
        • Geerdsen J.
        • et al.
        Anaesthesia for colonoscopy. An examination of the anaesthesia as an element of risk at colonoscopy.
        Acta Anaesthesiol Scand. 1986; 30: 60-63
        • Olsen E.A.
        • Brambrink A.M.
        Anesthesia for the young child undergoing ambulatory procedures: current concerns regarding harm to the developing brain.
        Curr Opin Anaesthesiol. 2013; 26: 677-684
        • Wilder R.T.
        • Flick R.P.
        • Sprung J.
        • et al.
        Early exposure to anesthesia and learning disabilities in a population-based birth cohort.
        Anesthesiology. 2009; 110: 796-804
        • Overholt B.F.
        • Brooks-Belli L.
        • Grace M.
        • et al.
        Withdrawal times and associated factors in colonoscopy: a quality assurance multicenter assessment.
        J Clin Gastroenterol. 2010; 44: e80-e86
        • Lieberman D.
        • Nadel M.
        • Smith R.A.
        • et al.
        Standardized colonoscopy reporting and data system: report of the Quality Assurance Task Group of the National Colorectal Cancer Roundtable.
        Gastrointest Endosc. 2007; 65: 757-766
        • Harewood G.C.
        • Sharma V.K.
        • de Garmo P.
        Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia.
        Gastrointest Endosc. 2003; 58: 76-79
        • Johnson D.A.
        • Barkun A.N.
        • Cohen L.B.
        • et al.
        Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer.
        Gastroenterology. 2014; 147: 903-924