Development and Adjustment of an Algorithm for Identifying Drug-Related Hospital Admissions in Pediatrics

Abstract

Objective: Adverse drug events (ADEs) in the outpatient pediatric pharmacotherapy can be serious and lead to inpatient admissions. Recent research only focused on ADE identification during hospitalization. The aim of the present study was to develop an algorithm to identify drugrelated hospital admissions in pediatrics.Methods: A systematic literature research was performed, and a pediatric trigger tool for identifying drug-related inpatient admissions was built. The initial version was tested in a sample of 292 patients admitted to a German university children's hospital. Subsequently, the tool was further improved by combining different modules as a novel approach. Results:The obtained algorithm with 39 triggers in 5 modules identified drug-related inpatient admissions at a sensitivity of 95.5% (95% confidence interval [CI], 89.3%-100%) and a specificity of 16.5% (95% CI, 11.9%-21.2%), respectively. After modifications including trigger activation requiring a combination of different modules, specificity increased to 56.9% (95% CI, 50.7%-63.0%). Identifying 36 of 44 ADEs leading to admission, sensitivity remained high (81.8% [95% CI, 70.4%-93.2%]). The overall positive predictive value was 25.2% (95% CI, 18.1%-32.3%). Conclusions:The algorithm is the first trigger tool to identify ambulant acquired ADEs leading to hospital admission in pediatrics. However, the underlying patient sample is small.Using a larger population for refinement will allow further specifications and reduction in the total amount of triggers and thus signals.

The epidemiology of drug-related hospital admissions in paediatrics – a systematic review

“…Training should include the procedure of medication review and knowledge of the most relevant drugs and clinical manifestations. Additionally, algorithms to identify drug-related hospital admissions could enable faster identification [ 48 , 64 , 69 , 71 , 77 , 103 ]. This would improve the efficiency of routine monitoring and reduce the cost of the procedure which is particularly important as financial and organisational requirements may otherwise discourage implementation.…”

Adverse Drug Reactions in Children: Comparison of Reports Collected in a Pharmacovigilance Project Versus Spontaneously Collected ADR Reports

“…Because of the study design [ 13 ], all KiDSafe reports originated from HCPs compared with 87.4% (609/697) of the EudraVigilance reports. More spontaneous than systematically collected reports were designated as life-threatening (13.7% vs. 8.3%), fatal (2.3% vs. 0.1%) and disabling (1.3% vs. 0.1%) [ESM Table 3].…”

“…Notably, oncological patients who were admitted as inpatients with a suspected ADR and had been in inpatient oncological treatment in the previous 4 weeks were excluded from the screening. The screening was performed by applying a standardized algorithm [ 13 ], identifying patients with a potential relationship between hospitalization and drug administration prior to admission. Cases with suspected ADRs detected by this algorithm were then reported to an independent expert group (Adverse Drug Event Expert Group) if consent for data processing was obtained.…”