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The emergency department (ED) abounds with hazards that might lead to adverse events (AEs). Clinicians must make frequent, high-consequence decisions with high diagnostic uncertainty as part of ad hoc teams taking care of patients not generally known to them.1 This occurs in the context of a sometimes chaotic environment with frequent interruptions, handoffs and shift changes. As a result, the ED tends to magnify cognitive biases that can result in AEs—particularly diagnostic AEs.2 This is especially problematic for children who account for 23 million ED visits in the USA annually and are particularly vulnerable to AEs. Children are developmentally less able to communicate specific symptoms and are evaluated in EDs with variable readiness to care for them.3 Yet, little is known about the occurrence and nature of AEs in paediatric ED patients.