Risk factors for near-miss events and safety incidents in pediatric radiation therapy

Nimrah Baig, Jiangxia Wang, Shereef Elnahal, Todd McNutt, Jean Wright, Theodore DeWeese, Stephanie Terezakis

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background and purpose: Factors contributing to safety- or quality-related incidents (e.g. variances) in children are unknown. We identified clinical and RT treatment variables associated with risk for variances in a pediatric cohort. Materials and methods: Using our institution's incident learning system, 81 patients age ≤21 years old who experienced variances were compared to 191 pediatric patients without variances. Clinical and RT treatment variables were evaluated as potential predictors for variances using univariate and multivariate analyses. Results: Variances were primarily documentation errors (n = 46, 57%) and were most commonly detected during treatment planning (n = 14, 21%). Treatment planning errors constituted the majority (n = 16 out of 29, 55%) of near-misses and safety incidents (NMSI), which excludes workflow incidents. Therapists reported the majority of variances (n = 50, 62%). Physician cross-coverage (OR = 2.1, 95% CI = 1.04–4.38) and 3D conformal RT (OR = 2.3, 95% CI = 1.11–4.69) increased variance risk. Conversely, age >14 years (OR = 0.5, 95% CI = 0.28–0.88) and diagnosis of abdominal tumor (OR = 0.2, 95% CI = 0.04–0.59) decreased variance risk. Conclusions: Variances in children occurred in early treatment phases, but were detected at later workflow stages. Quality measures should be implemented during early treatment phases with a focus on younger children and those cared for by cross-covering physicians.

Original languageEnglish (US)
Pages (from-to)178-182
Number of pages5
JournalRadiotherapy and Oncology
Issue number2
StatePublished - May 2018
Externally publishedYes

Bibliographical note

Funding Information:
J. Wang reports grants from the National Institutes of Health during the conduct of this study. S. Terezakis reports a grant from Elekta Industries outside the submitted work. N. Baig, S. Elnahal, T. McNutt, J. Wright, and T. DeWeese have no relevant disclosures to report.

Funding Information:
We would like to acknowledge support for the statistical analysis from the National Center for Research Resources and the National Center for Advancing Translational Sciences ( NCATS ) of the National Institutes of Health through Grant Number 1UL1TR001079 .


  • Incidents
  • Near-misses
  • Patient safety
  • Pediatrics
  • Quality
  • Variances

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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