JMIR Publications

ABSTRACT

Background:

Medication errors represent a major patient safety concern among hospitalized children due to developmental variability, weight-based dosing, and limited communication capacity. However, the global burden and determinants of pediatric inpatient medication errors remain insufficiently characterized.

Objective:

To estimate the worldwide incidence of medication errors in hospitalized pediatric patients and to identify factors associated with their occurrence.

Methods:

A systematic review and meta-analysis was conducted using Embase, MEDLINE, Web of Science, PubMed, and the Cochrane Library from database inception to June 2025. Observational studies involving pediatric inpatients aged <18 years were included. The review followed the MOOSE reporting guideline. Data were pooled using a DerSimonian–Laird random-effects model, with subgroup and sensitivity analyses performed to explore heterogeneity.

Results:

Sixty-one studies from 29 countries or regions were included. The pooled prescribing error rate was 28%, the proportion of patients experiencing medication errors was 54%, and the pooled administration error rate was 32%. Prescribing error rates were similar between cohort and cross-sectional studies. Higher error rates were observed in lower-middle–income countries, particularly in Latin America and the Caribbean, and in intensive care units. Error rates were comparable between antibiotic (30%) and non-antibiotic prescriptions (27%), but were higher in studies published from 2013–2025 (32%) than from 2000–2012 (18%). Risk factors for medication errors included intravenous administration, hospital stay >5 days, and polypharmacy (≥3 prescribed medications; OR, 2.12; 95% CI, 1.66–2.70).

Conclusions:

Medication errors are highly prevalent among hospitalized children worldwide, with substantial variation by region, income level, care setting, and time period. Errors are closely associated with treatment-related factors, underscoring the need for targeted system-level strategies to improve pediatric medication safety.