Global Prevalence and Associated Factors of Medication Errors in Hospitalized Pediatric Patients: Systematic Review and Meta-Analysis

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 This study aims to estimate the worldwide prevalence 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 younger than 18 years were included. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Data were pooled using a DerSimonian-Laird random-effects model, with subgroup and sensitivity analyses performed to explore heterogeneity. Results A total of 61 studies from 29 countries or regions were included. The pooled prescribing error rate was 28%, the pooled administration error rate was 32%, and 54% of the hospitalized pediatric patients experienced at least one medication error. Prescribing error rates were higher in lower-middle–income countries (44%), intensive care units (34%), antibiotic prescriptions (30%), and studies conducted between 2013 and 2025 (32%). The proportion of patients experiencing medication errors was the highest in upper-middle–income countries (64%), whereas administration error rates were the highest in low-income countries (71%), although these subgroup findings should be interpreted cautiously because of limited numbers of studies and wide CIs. Factors associated with medication errors included intravenous administration (odds ratio [OR] 6.86, 95% CI 3.17‐14.83), hospital stay longer than 5 days (OR 1.94, 95% CI 1.33‐2.81), and prescription of 3 or more 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.