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Angelo Marques Carizio F, do Vale de Souza I, de Oliveira AM, Corrêa Melo MM, Barbosa Zanetti MO, Rossi Varallo F, Régis Leira-Pereira L. Pharmacotherapy assessment and adverse drug reactions in older patients admitted to intensive care. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00099-0. [PMID: 39043496 DOI: 10.1016/j.farma.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 05/15/2024] [Accepted: 06/03/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Older patients are more susceptible to medication use, and physiological changes resulting from aging and organic dysfunctions presented by critically ill patients may alter the pharmacokinetic or pharmacodynamic behavior. Thus, critically ill older people present greater vulnerability to the occurrence of pharmacotherapeutic problems. OBJECTIVE To evaluate pharmacotherapy and the development of potential adverse drug reactions (ADRs) in older patients admitted to an intensive care unit (ICU). METHOD A cohort study was conducted in an ICU for adults of a Brazilian University Hospital during a 12-month period. The patients' pharmacotherapy was evaluated daily, considering the occurrence of ADRs and drug-drug interactions (DDIs), the use of potentially inappropriate medications (PIMs) for older people, and the pharmacotherapy anticholinergic burden (ACB). A trigger tool was used for active search of ADRs, with subsequent causality evaluation. PIM use was evaluated by means of the Beers criteria and the STOPP/START criteria. The ABC scale was employed to estimate ACB. The Micromedex® and Drugs.com® medication databases were employed to evaluate the DDIs. RESULTS The sample of this study consisted of 41 patients, with a mean age of 66.8 years old (±5.2). The 22 triggers used assisted in identifying 15 potential ADRs, and 26.8% of the patients developed them. The mean estimated ACB score was 3.0 (±1.8), and the patients used 3.1 (±1.4) and 3.3 (±1.6) PIMs according to the Beers and the STOPP criteria, respectively. A total of 672 DDIs were identified, with a mean of 16.8 (±9.5) DDIs/patient during ICU hospitalization. Our findings show an association between occurrence of ADRs in the ICU and polypharmacy (p=.03) and DDIs (p=.007), corroborating efforts for rational medication use as a preventive strategy. CONCLUSIONS Using tools to evaluate the pharmacotherapy for older people in intensive care can assist in the recognition and prevention of pharmacotherapeutic problems, with emphasis on the identification of ADRs through the observation of triggers and subsequent causality analysis.
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Affiliation(s)
- Fabiana Angelo Marques Carizio
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Isabella do Vale de Souza
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Alan Maicon de Oliveira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Madalena Corrêa Melo
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Olívia Barbosa Zanetti
- Department of Psychiatric Nursing and Human Sciences, College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Rossi Varallo
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Leonardo Régis Leira-Pereira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Comparison of the MOdified NARanjo Causality Scale (MONARCSi) for Individual Case Safety Reports vs. a Reference Standard. Drug Saf 2022; 45:1529-1538. [DOI: 10.1007/s40264-022-01245-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/26/2022]
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Sivagourounadin K, Rajendran P, Selvarajan S, Ganesapandian M. Agreement among different scales for causality assessment in drug-induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Curr Drug Saf 2021; 17:40-46. [PMID: 34126908 DOI: 10.2174/1574886316666210611160123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/03/2021] [Accepted: 04/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Identification of the offending drug is crucial and challenging in cases of severe cutaneous adverse drug reactions (CADR) like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Poor reproducibility and varying levels of agreement have been observed among different causality assessment tools (CATs) in assessing severe CADRs. This study was conducted to examine the agreement among four different CATs in assessing cases of drug-induced SJS, TEN and SJS/TEN overlap. METHODS All cases of drug-induced SJS, TEN and SJS/TEN overlap, which were reported between January 2012 and January 2020 were identified from the ADR register at an ADR monitoring center. Causality assessment was done in these reported cases using the following CATs: The World Health Organization-Uppsala Monitoring Centre (WHO-UMC) scale, Naranjo algorithm, Liverpool algorithm and Algorithm of drug causality for epidermal necrolysis (ALDEN). Weighted kappa (κw) test was used to calculate the agreement among four CATs. RESULTS A total of 30 cases of drug-induced SJS, TEN and SJS/TEN overlap were included in our analyses. The most common offending group of drugs were anticonvulsants (46.7%), antimicrobials (40%) and nonsteroidal anti-inflammatory drugs (13.3%). Of the anticonvulsants, phenytoin (13.3%), carbamazepine (10%) and valproate (10%) were the commonly reported offending drugs. Poor agreement was observed among the four different causality assessment scales. CONCLUSION Discrepancies were observed among four different CATs in assessing drug-induced SJS and TEN. A CAT that is more specific to drug-induced SJS and TEN, simple, user-friendly with limited subjective interpretation, incorporating new immunological and pharmacogenetic markers is necessary.
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Affiliation(s)
- Kiruthika Sivagourounadin
- Department of Pharmacology, Sri Manakula Vinayagar Medical college and hospital, Puducherry-605017, India
| | - Priyadharsini Rajendran
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry-605006, India
| | - Sandhiya Selvarajan
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry-605006, India
| | - Mahalakshmi Ganesapandian
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry-605006, India
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Gates PJ, Baysari MT, Mumford V, Raban MZ, Westbrook JI. Standardising the Classification of Harm Associated with Medication Errors: The Harm Associated with Medication Error Classification (HAMEC). Drug Saf 2020; 42:931-939. [PMID: 31016678 PMCID: PMC6647434 DOI: 10.1007/s40264-019-00823-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Classifying harm associated with a medication error can be time consuming and labour intensive and limited studies undertake this step. There is no standardised process, and few studies that report harm assessment provide adequate methods to allow for study replication. Studies typically mention that a clinical review panel classified patient harm and provide a reference to a classification tool. Moreover, in many studies it is unclear whether potential or actual harm was classified as studies refer only to ‘error severity’. The tools used to categorise the severity of patient harm vary widely across studies and few have been assessed for inter-rater reliability and criterion validity. In this paper, we describe the systematic process we undertook to synthesise the defining elements and strengths, while mitigating the limitations, of existing harm classification tools to derive the Harm Associated with Medication Error Classification (HAMEC). This new tool provides a harm classification for use across clinical and research settings. The provision of an explicit process for its application and guiding category descriptors are designed to reduce the risk of misclassification and produce results that are comparable across studies. As the World Health Organisation embarks on its international safety challenge of reducing medication-related harm by 50%, accompanying methodological advances are required to measure progress.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
| | - Melissa T Baysari
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Virginia Mumford
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Witcher R, Tracy J, Santos L, Chopra A. Outcomes and Adverse Effects With Peramivir for the Treatment of Influenza H1N1 in Critically Ill Pediatric Patients. J Pediatr Pharmacol Ther 2019; 24:497-503. [PMID: 31719811 DOI: 10.5863/1551-6776-24.6.497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Influenza is an environmental pathogen and infection presents as a range from asymptomatic to fulminant illness. Though treatment is supportive, antiviral agents have a role in the management of infection. Pediatric use of peramivir is largely based on reports and extrapolations of pharmacokinetic data. We seek to describe efficacy and safety of peramivir in critically ill pediatric patients. METHODS This is a retrospective, institutional review board-approved chart review of all patients under 21 years of age, admitted to the PICU, and treated with peramivir for influenza H1N1 infection between January 1, 2016, and March 31, 2016, at a single-center, 12-bed PICU. The primary outcome was time to sustained resolution of fever; secondary outcomes included dose, duration, and adverse effects of peramivir therapy. RESULTS Seven patients were included with median age of 3.7 years. Median time to sustained resolution of fever was 49.3 hours, median duration of mechanical ventilation was 14.2 days, median ICU LOS was 18.7 days, and hospital LOS was 24.7 days. No patients suffered mortality. Three patients experienced leukopenia, one of which experienced a concurrent neutropenia. Three patients experienced hyperglycemia, 2 experienced hypertension, 1 experienced increased aspartate aminotransferase and increased alanine aminotransferase, and 1 experienced diarrhea. All adverse events assessed were classified as possible using published adverse event causality assessments. CONCLUSIONS Peramivir has been shown to be an effective therapy for the treatment of influenza H1N1 in critically ill pediatric patients. In our experience with 7 pediatric patients, peramivir was well tolerated at typical durations of therapy; however, increased vigilance is warranted during prolonged courses or in patients with reasons for altered pharmacokinetics and pharmacodynamics.
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Comfort S, Dorrell D, Meireis S, Fine J. MOdified NARanjo Causality Scale for ICSRs (MONARCSi): A Decision Support Tool for Safety Scientists. Drug Saf 2019; 41:1073-1085. [PMID: 29876835 PMCID: PMC6182464 DOI: 10.1007/s40264-018-0690-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Introduction Within the field of Pharmacovigilance, the most common approaches for assessing causality between a report of a drug and a corresponding adverse event are clinical judgment, probabilistic methods and algorithms. Although multiple methods using these three approaches have been proposed, there is currently no universally accepted method for assessing drug-event causality in ICSRs and variability in drug-event causality assessments is well documented. Objective This study describes the development and validation of an Individual Case Safety Report (ICSR) Causality Decision Support Tool to assist Safety Professionals (SPs) performing causality assessments. Methods Roche developed this model with nine drug-event pair features capturing important aspects of Naranjo’s scoring system, selected Bradford–Hill criteria, and internal Roche safety practices. Each of the features was weighted based on individual safety professional (n = 65) assessments of the importance of that feature when assessing causality, using an ordinal weighting scale (0 = no importance, 4 = very high importance). The mean and associated standard deviation for each feature weight was calculated and were used as inputs to a fitted logistic equation, which calculated the probability of a causal relationship between the drug and adverse event. Model training, validation, and testing were conducted by comparing MONARCSi causality classifications to previous company causality assessments for 978 randomly selected, clinical trial drug-event pairs based on their respective features and weights. Results The final model test, a two-by-two comparison of the results, showed substantial agreement (Gwet Kappa = 0.77) between MONARCSi and Roche safety professionals’ assessments of causality, using global introspection. The model exhibited moderate sensitivity (65%) and high specificity (93%), high positive and negative predictive values (79 and 88%, respectively), and an F1 score of 71%. Conclusion Analysis suggests that the MONARCSi model could potentially be a useful decision support tool to assist pharmacovigilance safety professionals when evaluating drug-event causality in a consistent and documentable manner. Electronic supplementary material The online version of this article (10.1007/s40264-018-0690-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shaun Comfort
- Genentech, Inc-A Member of the Roche Group, 1 DNA Way, B35-7 North, South San Francisco, CA, 94080, USA.
| | - Darren Dorrell
- Genentech, Inc-A Member of the Roche Group, 1 DNA Way, B35-7 North, South San Francisco, CA, 94080, USA
| | - Shawman Meireis
- Genentech, Inc-A Member of the Roche Group, 1 DNA Way, B35-7 North, South San Francisco, CA, 94080, USA
| | - Jennifer Fine
- Genentech, Inc-A Member of the Roche Group, 1 DNA Way, B35-7 North, South San Francisco, CA, 94080, USA
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Riva N, Dip M, Halac E, Cáceres Guido P, Woillard JB, Licciardone N, Chan D, Buendía J, Borgnia D, Bosaleh A, de Davila MT, Imventarza O, Schaiquevich P. Survival Time to Biopsy-Proven Acute Rejection and Tacrolimus Adverse Drug Reactions in Pediatric Liver Transplantation. Ther Drug Monit 2018; 40:401-410. [PMID: 29621122 DOI: 10.1097/ftd.0000000000000517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Despite advances in surgical procedures and the optimization of immunosuppressive therapies in pediatric liver transplantation, acute rejection (AR) and serious adverse drug reaction (ADR) to tacrolimus still contribute to morbidity and mortality. Identifying risk factors of safety and efficacy parameters may help in optimizing individual immunosuppressive therapies. This study aimed to identify peritransplant predictors of AR and factors related to the risk of ADR to tacrolimus in a large Latin American cohort of pediatric liver transplant patients. METHODS We performed a retrospective cohort study in a pediatric liver transplant population (n = 72). Peritransplant variables were collected retrospectively including demographic, clinical, laboratory parameters, genomic (CYP3A5 donor and recipients polymorphism), and tacrolimus trough concentrations (C0) over a 2-year follow-up period. Variability in tacrolimus C0 was calculated using percent coefficient of variation and tortuosity. ADR- and AR-free survival rates were calculated using the Kaplan-Meier method, and risk factors were identified by multivariate Cox regression models. RESULTS Cox-proportional hazard models identified that high tortuosity in tacrolimus C0 was associated with an 80% increased risk of AR [hazard ratio (HR), 1.80; 95% confidence interval (CI), 1.01-3.22; P < 0.05], whereas steroid in maintenance doses decreased this risk (HR, 0.56; 95% CI, 0.31-0.99; P < 0.05). Forty-six patients experienced at least one ADR including hypomagnesemia, nephrotoxicity, hypertension, malignancies, and tremor as a first event. Multivariate analysis showed that C0 values 10 days before the event (HR, 1.25; 95% CI, 1.21-1.39; P < 0.0001) and CYP3A5 expresser recipients (HR, 2.05; 95% CI, 1.03-4.06; P < 0.05) were independent predictors of ADR. CONCLUSIONS Tacrolimus C0 values, its variability, and CYP3A5 polymorphisms were identified as risk factors of AR and tacrolimus ADR. This knowledge may help to control and reduce their incidence in pediatric liver transplant patients. Prospective studies are important to validate these results.
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Affiliation(s)
- Natalia Riva
- Unit of Clinical Pharmacokinetics, Hospital de Pediatría J.P. Garrahan
| | - Marcelo Dip
- Liver Transplant Service, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
| | - Esteban Halac
- Liver Transplant Service, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
| | | | - Jean B Woillard
- Department of Pharmacology and Toxicology, Centre Hospitalier Universitaire à Limoges, Limoges, France
| | | | - Debora Chan
- Basic Science-Mathematics, Universidad Tecnológica Nacional
| | | | | | | | | | - Oscar Imventarza
- Liver Transplant Service, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
| | - Paula Schaiquevich
- Unit of Clinical Pharmacokinetics, Hospital de Pediatría J.P. Garrahan.,National Scientific and Technical Research Council, CONICET, Buenos Aires, Argentina
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Gautron S, Wentzell J, Kanji S, Nguyen T, Kobewka DM, MacDonald E. Characterization of Serious Adverse Drug Reactions in Hospital to Determine Potential Implications of Mandatory Reporting. Can J Hosp Pharm 2018; 71:316-323. [PMID: 30401998 PMCID: PMC6209500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The Protecting Canadians from Unsafe Drugs Act will eventually require institutions to report all serious adverse drug reactions (ADRs), although the proposed regulations do not yet define what will need to be reported and by whom. Knowledge about the occurrence of serious ADRs in the hospital setting is needed to optimize the effectiveness of reporting and to determine the potential implications of mandatory reporting. OBJECTIVES To quantify and characterize suspected serious ADRs in patients admitted to a general medicine service, to assess the likelihood of causality, and to determine inter-rater agreement for identification of ADRs and assessment of their likelihood. METHODS This prospective observational study involved 60 consecutive patients admitted to a general medicine service at a tertiary care teaching centre starting on March 28, 2016. The primary outcome was the number of serious ADRs, defined by Health Canada as ADRs that result in hospital admission, congenital malformation, persistent or significant disability or incapacity, or death; that are life-threatening; or that require significant intervention to prevent one of these outcomes. Medical records were reviewed independently by pairs of pharmacists for serious ADRs, and the likelihood of causality was assessed using the World Health Organization-Uppsala Monitoring Centre system. Inter-rater agreement was calculated using the kappa score, and disagreements were resolved by discussion and consensus. RESULTS Twenty-three serious ADRs occurred in the sample of 60 patients. The proportion of patients experiencing a serious ADR that contributed to the original hospital admission was 19/60 (32%, 95% confidence interval [CI] 20%-43%), and 4 patients (7%, 95% CI 0%-13%) experienced a serious ADR during their hospital stay. Inter-rater agreement for occurrence of serious ADRs was moderate (kappa 0.58, 95% CI 0.35-0.76). CONCLUSION Reportable serious ADRs were common among patients admitted to a general medicine service. Canadian hospitals would face difficulties reporting all serious ADRs because of the frequency of their occurrence and the subjectivity of their identification.
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Affiliation(s)
- Stephanie Gautron
- ,BScPharm, ACPR, was, at the time of this study, a pharmacy resident at The Ottawa Hospital, Ottawa, Ontario. She is now a Pharmacist with the Centre de santé Saint-Boniface, My Health Team, St Boniface/St Vital, Winnipeg, Manitoba
| | - Jason Wentzell
- ,BScPharm, ACPR, BCOP, is a Pharmacist with The Ottawa Hospital and a Clinician Investigator with The Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Salmaan Kanji
- ,BScPharm, ACPR, PharmD, is a Clinical Pharmacy Specialist with The Ottawa Hospital and an Associate Scientist with The Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Tiffany Nguyen
- ,BScPharm, ACPR, BCOP, is a Pharmacist with The Ottawa Hospital and a Clinician Investigator with The Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Daniel M Kobewka
- ,MD, FRCPC, MSc, is a Staff Physician with the Department of Medicine, The Ottawa Hospital; a Clinician Investigator with The Ottawa Hospital Research Institute; and an Assistant Professor with the University of Ottawa, Ottawa, Ontario
| | - Erika MacDonald
- ,BScPharm, ACPR, MSc, is the Professional Practice Coordinator and a Pharmacist with The Ottawa Hospital and a Clinician Investigator with The Ottawa Hospital Research Institute, Ottawa, Ontario
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Comparison of different methods for causality assessment of adverse drug reactions. Int J Clin Pharm 2018; 40:903-910. [PMID: 30051231 DOI: 10.1007/s11096-018-0694-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 07/12/2018] [Indexed: 01/01/2023]
Abstract
Background The causality assessment of adverse drug reactions (ADRs) remains a challenge, and none of the different available method of causality assessment used for assessing adverse reactions has been universally accepted as the gold standard. Objective To examine the agreement and correlation among three broad approaches for causality assessment of ADRs viz. World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system, Naranjo algorithm, and updated Logistic method. Setting ADR monitoring centre (AMC) of a tertiary care teaching hospital in India. Method A total of 230 cases of ADR from April 2017 to August 2017 were retrospectively analyzed by each of these three methods. The agreement among the different methods was calculated by Cohen's kappa (κ), and Spearman's correlation was used to find the correlation among these methods. Main outcome measures Cohen's kappa value and Spearman's correlation coefficient for comparison among the different methods. Results The Cohen's κ used for analyzing the agreement between WHO-UMC system and Naranjo algorithm was 0.45, between WHO-UMC system and updated Logistic method was 0.405, and between Naranjo algorithm and updated Logistic method was 0.606. The Spearman's correlation coefficient was 0.793 for Naranjo algorithm vs. updated Logistic method, 0.735 for WHO-UMC system vs. Naranjo algorithm, and 0.696 for WHO-UMC system vs. updated Logistic method. Conclusion Causality assessment based on objective measurements (scores and probabilities) like updated Logistic method and Naranjo algorithm are less prone to subjective variations compared to the WHO-UMC system which is based on expert judgement.
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Straw LB, Dodson CR, Schrift DS. Dexmedetomidine-induced fever and delirium: A case report. J Clin Pharm Ther 2018; 43:430-433. [PMID: 29574851 DOI: 10.1111/jcpt.12680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/23/2018] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Dexmedetomidine is a selective alpha-2 agonist used for sedation in the intensive care unit (ICU). CASE DESCRIPTION A 41-year-old woman intubated in the ICU and being treated for acute respiratory distress syndrome (ARDS) received dexmedetomidine following successful extubation to treat increasing agitation thought to be secondary to a history of polysubstance abuse. Following initiation of the dexmedetomidine, the patient became febrile as well as increasingly more agitated and delirious. All potential fever or delirium causes were evaluated. Following discontinuation of dexmedetomidine, her fever, agitation and delirium ceased. WHAT IS NEW AND CONCLUSION We depict the first known case of dexmedetomidine causing high fevers and delirium.
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Affiliation(s)
- L B Straw
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - C R Dodson
- Palmetto Health Richland, Department of Pharmacy, Columbia, SC, USA
| | - D S Schrift
- Palmetto Health-USC Medical Group, Palmetto Health Richland Division of Pulmonary and Critical Care Medicine, Columbia, SC, USA
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Ribeiro MR, Motta AA, Marcondes-Fonseca LA, Kalil-Filho J, Giavina-Bianchi P. Increase of 10% in the Rate of Adverse Drug Reactions for Each Drug Administered in Hospitalized Patients. Clinics (Sao Paulo) 2018; 73:e185. [PMID: 29451619 PMCID: PMC5784181 DOI: 10.6061/clinics/2018/e185] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/17/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the risk factors, incidence and severity of adverse drug reactions in in-patients. METHODS This prospective study evaluated 472 patients treated at a teaching hospital in Brazil between 2010 and 2013 by five medical specialties: Internal Medicine, General Surgery, Geriatrics, Neurology, and Clinical Immunology and Allergy. The following variables were assessed: patient age, gender, comorbidities, family history of hypersensitivity, personal and family history of atopy, number of prescribed drugs before and during hospitalization, hospital diagnoses, days of hospitalization. The patients were visited every other day, and medical records were reviewed by the investigators to detect adverse drug reactions. RESULTS There were a total of 94 adverse drug reactions in 75 patients. Most reactions were predictable and of moderate severity. The incidence of adverse drug reactions was 16.2%, and the incidence varied, according to the medical specialty; it was higher in Internal Medicine (30%). Antibiotics were the most commonly involved medication. Chronic renal failure, longer hospital stay, greater number of diagnoses and greater number of medications upon admission were risk factors. For each medication introduced during hospitalization, there was a 10% increase in the rate of adverse drug reaction. In the present study, the probability of observing an adverse drug reaction was 1 in 104 patients per day. CONCLUSIONS Adverse drug reactions are frequent and potentially serious and should be better monitored in patients with chronic renal failure or prolonged hospitalization and especially in those on 'polypharmacy' regimens. The rational use of medications plays an important role in preventing adverse drug reactions.
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Affiliation(s)
- Marisa Rosimeire Ribeiro
- Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, BR
| | - Antonio Abílio Motta
- Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, BR
| | | | - Jorge Kalil-Filho
- Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, BR
| | - Pedro Giavina-Bianchi
- Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, BR
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Krüger BD, Kurmann J, Corti N, Spahn DR, Bettex D, Rudiger A. Dexmedetomidine-Associated Hyperthermia. Anesth Analg 2017; 125:1898-1906. [DOI: 10.1213/ane.0000000000002353] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ostermann M, Chawla LS, Forni LG, Kane-Gill SL, Kellum JA, Koyner J, Murray PT, Ronco C, Goldstein SL. Drug management in acute kidney disease - Report of the Acute Disease Quality Initiative XVI meeting. Br J Clin Pharmacol 2017; 84:396-403. [PMID: 29023830 DOI: 10.1111/bcp.13449] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/09/2017] [Accepted: 09/20/2017] [Indexed: 12/18/2022] Open
Abstract
AIMS To summarize and extend the main conclusions and recommendations relevant to drug management during acute kidney disease (AKD) as agreed at the 16th Acute Disease Quality Initiative (ADQI) consensus conference. METHODS Using a modified Delphi method to achieve consensus, experts attending the 16th ADQI consensus conference reviewed and appraised the existing literature on drug management during AKD and identified recommendations for clinical practice and future research. The group focussed on drugs with one of the following characteristics: (i) predominant renal excretion; (ii) nephrotoxicity; (iii) potential to alter glomerular function; and (iv) presence of metabolites that are modified in AKD and may affect other organs. RESULTS We recommend that medication reconciliation should occur at admission and discharge, at AKD diagnosis and change in AKD phase, and when the patient's condition changes. Strategies to avoid adverse drug reactions in AKD should seek to minimize adverse events from overdosing and nephrotoxicity and therapeutic failure from under-dosing or incorrect drug selection. Medication regimen assessment or introduction of medications during the AKD period should consider the nephrotoxic potential, altered renal and nonrenal elimination, the effects of toxic metabolites and drug interactions and altered pharmacodynamics in AKD. A dynamic monitoring plan including repeated serial assessment of clinical features, utilization of renal diagnostic tests and therapeutic drug monitoring should be used to guide medication regimen assessment. CONCLUSIONS Drug management during different phases of AKD requires an individualized approach and frequent re-assessment. More research is needed to avoid drug associated harm and therapeutic failure.
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Affiliation(s)
- Marlies Ostermann
- Department of Intensive Care, King's College London, Guy's & St Thomas' NHS Foundation Hospital, London, UK
| | - Lakhmir S Chawla
- Department of Medicine, Veterans Affairs Medical Center, Washington, DC, USA
| | - Lui G Forni
- Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | | | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, USA
| | - Jay Koyner
- Department of Medicine, University of Chicago, Chicago, USA
| | - Patrick T Murray
- UCD School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Stuart L Goldstein
- Cincinnati Children's Hospital Medical Center, Division of Nephrology and Hypertension, Cincinnati, USA
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Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol 2017; 13:241-257. [PMID: 28239173 DOI: 10.1038/nrneph.2017.2] [Citation(s) in RCA: 919] [Impact Index Per Article: 131.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney disease for a period of >90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the disease process. For patients in whom pathophysiologic processes are ongoing, the term acute kidney disease (AKD) has been proposed to define the course of disease after AKI; however, definitions of AKD and strategies for the management of patients with AKD are not currently available. In this consensus statement, the Acute Disease Quality Initiative (ADQI) proposes definitions, staging criteria for AKD, and strategies for the management of affected patients. We also make recommendations for areas of future research, which aim to improve understanding of the underlying processes and improve outcomes for patients with AKD.
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Varallo FR, Planeta CS, Herdeiro MT, Mastroianni PDC. Imputation of adverse drug reactions: Causality assessment in hospitals. PLoS One 2017; 12:e0171470. [PMID: 28166274 PMCID: PMC5293251 DOI: 10.1371/journal.pone.0171470] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/20/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND & OBJECTIVES Different algorithms have been developed to standardize the causality assessment of adverse drug reactions (ADR). Although most share common characteristics, the results of the causality assessment are variable depending on the algorithm used. Therefore, using 10 different algorithms, the study aimed to compare inter-rater and multi-rater agreement for ADR causality assessment and identify the most consistent to hospitals. METHODS Using ten causality algorithms, four judges independently assessed the first 44 cases of ADRs reported during the first year of implementation of a risk management service in a medium complexity hospital in the state of Sao Paulo (Brazil). Owing to variations in the terminology used for causality, the equivalent imputation terms were grouped into four categories: definite, probable, possible and unlikely. Inter-rater and multi-rater agreement analysis was performed by calculating the Cohen´s and Light´s kappa coefficients, respectively. RESULTS None of the algorithms showed 100% reproducibility in the causal imputation. Fair inter-rater and multi-rater agreement was found. Emanuele (1984) and WHO-UMC (2010) algorithms showed a fair rate of agreement between the judges (k = 0.36). INTERPRETATION & CONCLUSIONS Although the ADR causality assessment algorithms were poorly reproducible, our data suggest that WHO-UMC algorithm is the most consistent for imputation in hospitals, since it allows evaluating the quality of the report. However, to improve the ability of assessing the causality using algorithms, it is necessary to include criteria for the evaluation of drug-related problems, which may be related to confounding variables that underestimate the causal association.
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Affiliation(s)
- Fabiana Rossi Varallo
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Araraquara, São Paulo, Brazil
- CAPES Foundation, Ministry of Education of Brazil, Brasília—DF, Brazil
| | - Cleopatra S. Planeta
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Araraquara, São Paulo, Brazil
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16
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Witcher R, Dzierba AL, Kim C, Smithburger PL, Kane-Gill SL. Adverse drug reactions in therapeutic hypothermia after cardiac arrest. Ther Adv Drug Saf 2016; 8:101-111. [PMID: 28382198 DOI: 10.1177/2042098616679813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Therapeutic hypothermia (TH) improves survival and neurologic function in comatose survivors of cardiac arrest. Many medications used to support TH have altered pharmacokinetics and pharmacodynamics during this treatment. It is unknown if or at what frequency the medications used during TH cause adverse drug reactions (ADRs). METHODS A retrospective chart review was conducted for patients admitted to an intensive care unit (ICU) after cardiac arrest and treated with TH from January 2009 to June 2012 at two urban, university-affiliated, tertiary-care medical centres. Medications commonly used during TH were screened for association with significant ADRs (grade 3 or greater per Common Terminology Criteria for Adverse Events) using three published ADR detection instruments. RESULTS A total of 229 patients were included, the majority being males with median age of 62 presenting with an out-of-hospital cardiac arrest in pulseless electrical activity or asystole. The most common comorbidities were hypertension, coronary artery disease, and diabetes mellitus. There were 670 possible ADRs and 69 probable ADRs identified. Of the 670 possible ADRs, propofol, fentanyl, and acetaminophen were the most common drugs associated with ADRs. Whereas fentanyl, insulin, and propofol were the most common drugs associated with a probable ADR. Patients were managed with TH for a median of 22 hours, with 38% of patients surviving to hospital discharge. CONCLUSIONS Patients undergoing TH after cardiac arrest frequently experience possible adverse reactions associated with medications and the corresponding laboratory abnormalities are significant. There is a need for judicious use and close monitoring of drugs in the setting of TH until recommendations for dose adjustments are available to help prevent ADRs.
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Affiliation(s)
- Robert Witcher
- New York University Langone Medical Centre, New York, NY, USA
| | | | - Catherine Kim
- University of Pittsburgh, School of Pharmacy, Pittsburgh, PA, USA Department of Pharmacy, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| | - Pamela L Smithburger
- University of Pittsburgh, School of Pharmacy, Pittsburgh, PA, USA Department of Pharmacy, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| | - Sandra L Kane-Gill
- School of Pharmacy, University of Pittsburgh, 918 Salk Hall, 3501 Terrace Street, Pittsburgh, PA 15261, USA
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17
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Jolivot PA, Pichereau C, Hindlet P, Hejblum G, Bigé N, Maury E, Guidet B, Fernandez C. An observational study of adult admissions to a medical ICU due to adverse drug events. Ann Intensive Care 2016; 6:9. [PMID: 26830112 PMCID: PMC4735088 DOI: 10.1186/s13613-016-0109-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/12/2016] [Indexed: 11/30/2022] Open
Abstract
Background The objectives of the study were to estimate the incidence of intensive care unit (ICU) admissions due to adverse drug events (ADEs), to assess preventability, severity and costs of the corresponding ADE and to determine the leading causes of preventable ADEs. Methods An observational study was conducted in a medical ICU of a teaching hospital from February 2013 to February 2014. Results A total of 743 consecutive admissions were included, and they involved 701 different patients. The included admissions were categorized into three groups (admissions due to preventable ADE, admissions due to unpreventable ADE and the control group). Among the 743 ICU admissions included during the study period, 173 (23.3 %) were due to ADE, with 102 (13.7 %) related to preventable ADE and 71 (9.6 %) to unpreventable ADE, yielding a preventability rate of ADE of 0.59 (102/173). Admissions due to unpreventable ADE concerned patients with more comorbidities, a greater number of drugs and higher Simplified Acute Physiology Score II than admissions due to preventable ADE and the control group admissions (n = 570). Hospital mortality rates, corresponding costs and length of stay were all similar in the preventable ADE and control groups, whereas they were always significantly higher in the unpreventable ADE group. ICU mortality, length of stay and the corresponding costs were similar in the three groups. Non-compliance was the principal leading cause of preventable ADE (n = 31/102). The 102 preventable ADE-related admissions accounted for a total of 528 days of hospitalization in the ICU, requiring a mean of 1.4 ICU beds per day over the one-year period, with an associated total cost amounting to 747,651 €. Conclusions ADE was a major cause of admission in the studied ICU, and in 59 % of the cases, ADEs were preventable. The reported burden of ICU admissions due to ADE advocates for further investigations to explore how the rate of such admissions could be decreased. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0109-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pierre-Alain Jolivot
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Equipe 6, 75012, Paris, France.,APHP, Hôpital Saint-Antoine, Service de Pharmacie, 75012, Paris, France
| | - Claire Pichereau
- APHP, Hôpital Saint-Antoine, Service de Réanimation Médicale, 75012, Paris, France
| | - Patrick Hindlet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Equipe 6, 75012, Paris, France.,APHP, Hôpital Saint-Antoine, Service de Pharmacie, 75012, Paris, France.,Univ Paris-Sud, Faculté de Pharmacie, 92296, Châtenay-Malabry, France
| | - Gilles Hejblum
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Equipe 6, 75012, Paris, France
| | - Naïke Bigé
- APHP, Hôpital Saint-Antoine, Service de Réanimation Médicale, 75012, Paris, France
| | - Eric Maury
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Equipe 6, 75012, Paris, France.,APHP, Hôpital Saint-Antoine, Service de Réanimation Médicale, 75012, Paris, France
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Equipe 6, 75012, Paris, France.,APHP, Hôpital Saint-Antoine, Service de Réanimation Médicale, 75012, Paris, France
| | - Christine Fernandez
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Equipe 6, 75012, Paris, France. .,APHP, Hôpital Saint-Antoine, Service de Pharmacie, 75012, Paris, France. .,Univ Paris-Sud, Faculté de Pharmacie, 92296, Châtenay-Malabry, France.
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Taylor SA, Vittorio JM, Martinez M, Fester KA, Lagana SM, Lobritto SJ, Ovchinsky N. Anakinra-Induced Acute Liver Failure in an Adolescent Patient with Still's Disease. Pharmacotherapy 2016; 36:e1-4. [DOI: 10.1002/phar.1677] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Sarah A. Taylor
- Lurie Children's Hospital of Chicago; Chicago Illinois
- Columbia University Medical Center; New York New York
| | | | | | - Keith A. Fester
- Columbia University Medical Center; New York New York
- Barnes-Jewish Hospital; St Louis Missouri
| | | | | | - Nadia Ovchinsky
- Columbia University Medical Center; New York New York
- Children's Hospital at Montefiore; Bronx New York
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Ryu J, Lee H, Suh J, Yang M, Kang W, Kim E. Differences between Drug-Induced and Contrast Media-Induced Adverse Reactions Based on Spontaneously Reported Adverse Drug Reactions. PLoS One 2015; 10:e0142418. [PMID: 26544039 PMCID: PMC4636266 DOI: 10.1371/journal.pone.0142418] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 10/21/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We analyzed differences between spontaneously reported drug-induced (not including contrast media) and contrast media-induced adverse reactions. METHODS Adverse drug reactions reported by an in-hospital pharmacovigilance center (St. Mary's teaching hospital, Daejeon, Korea) from 2010-2012 were classified as drug-induced or contrast media-induced. Clinical patterns, frequency, causality, severity, Schumock and Thornton's preventability, and type A/B reactions were recorded. The trends among causality tools measuring drug and contrast-induced adverse reactions were analyzed. RESULTS Of 1,335 reports, 636 drug-induced and contrast media-induced adverse reactions were identified. The prevalence of spontaneously reported adverse drug reaction-related admissions revealed a suspected adverse drug reaction-reporting rate of 20.9/100,000 (inpatient, 0.021%) and 3.9/100,000 (outpatients, 0.004%). The most common adverse drug reaction-associated drug classes included nervous system agents and anti-infectives. Dermatological and gastrointestinal adverse drug reactions were most frequently and similarly reported between drug and contrast media-induced adverse reactions. Compared to contrast media-induced adverse reactions, drug-induced adverse reactions were milder, more likely to be preventable (9.8% vs. 1.1%, p < 0.001), and more likely to be type A reactions (73.5% vs. 18.8%, p < 0.001). Females were over-represented among drug-induced adverse reactions (68.1%, p < 0.001) but not among contrast media-induced adverse reactions (56.6%, p = 0.066). Causality patterns differed between the two adverse reaction classes. The World Health Organization-Uppsala Monitoring Centre causality evaluation and Naranjo algorithm results significantly differed from those of the Korean algorithm version II (p < 0.001). CONCLUSIONS We found differences in sex, preventability, severity, and type A/B reactions between spontaneously reported drug and contrast media-induced adverse reactions. The World Health Organization-Uppsala Monitoring Centre and Naranjo algorithm causality evaluation afforded similar results.
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Affiliation(s)
- JiHyeon Ryu
- Evidence-Based Research Laboratory, Department of Clinical Pharmacy and Pharmaceutical Care, College of Pharmacy, Chung-Ang University, Seoul, South Korea
- Department of Pharmacy, Division of Pharmacovigilance, Saint Mary’s Hospital, Daejeon, South Korea
| | - HeeYoung Lee
- Evidence-Based Research Laboratory, Department of Clinical Pharmacy and Pharmaceutical Care, College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - JinUk Suh
- Department of Pharmaceutical Industry, ChungAng University, Seoul, South Korea
| | - MyungSuk Yang
- Department of Pharmaceutical Industry, ChungAng University, Seoul, South Korea
| | - WonKu Kang
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
- * E-mail: (EK); (WK)
| | - EunYoung Kim
- Evidence-Based Research Laboratory, Department of Clinical Pharmacy and Pharmaceutical Care, College of Pharmacy, Chung-Ang University, Seoul, South Korea
- Department of Pharmaceutical Industry, ChungAng University, Seoul, South Korea
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
- * E-mail: (EK); (WK)
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Jolivot PA, Hindlet P, Pichereau C, Fernandez C, Maury E, Guidet B, Hejblum G. A systematic review of adult admissions to ICUs related to adverse drug events. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:643. [PMID: 25529263 PMCID: PMC4422001 DOI: 10.1186/s13054-014-0643-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Adverse drug events (ADE) may lead to hospital admission, and in some cases admission to an ICU is mandatory. We conducted a systematic review dealing with the incidence of ADE requiring ICU admission in adult patients, the reference population being all ICU admissions. Medline, Embase and Web of Science databases were screened from January 1982 to July 2014, using appropriate key words. Only original articles in English reporting the incidence of ADE requiring ICU admission in adult patients among total ICU admissions were included. Article eligibility was assessed by two independent reviewers, a third being involved in cases of disagreement. All reported characteristics (type of ICU, characteristics of patients, incidence of ADE, severity and preventability, drugs involved, causality) in the selected articles were collected for the review. The quality of studies was independently assessed by two reviewers with a specific score that we developed. A meta-analysis was conducted. Inclusion criteria were fulfilled by 11 studies out of the 4,311 identified in the initial literature search. The median (interquartile) quality score was 0.61 (0.44; 0.69). The reported incidences of ADE requiring ICU admission in adult patients ranged from 0.37 to 27.4%, with an associated mortality rate ranging from 2 to 28.1% and a mean length of stay ranging from 2.3 to 6.4 days. Preventable events accounted for 17.5 to 85.7% of the events. Costs and mechanisms at the root of ADE were investigated in only two and five studies, respectively. The forest plot examining the incidence of ADE requiring ICU admission in adult patients was associated with high heterogeneity (I2 statistic >98%), and the shape of the corresponding funnel plot was asymmetric. Heterogeneity across studies concerned many features, including studied populations, events considered, causality assessment methods, definitions of preventability and severity. Despite the heterogeneity of the reports, our review indicates that ICU admission due to ADE is a significant issue that should deserve further interest. The review led us to propose a list of items devoted to the reporting of future studies on ADE requiring ICU admissions.
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Affiliation(s)
- Pierre-Alain Jolivot
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, F-75013, Paris, France. .,Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR_S 1136, F-75013, Paris, France. .,AP-HP, Hôpital Saint-Antoine, Service de Pharmacie, F-75012, Paris, France.
| | - Patrick Hindlet
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, F-75013, Paris, France. .,Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR_S 1136, F-75013, Paris, France. .,AP-HP, Hôpital Saint-Antoine, Service de Pharmacie, F-75012, Paris, France. .,Univ Paris-Sud, Faculté de Pharmacie, F-92296, Chatenay-Malabry, France.
| | - Claire Pichereau
- AP-HP, Hôpital Saint-Antoine, Service de Réanimation, F-75012, Paris, France.
| | - Christine Fernandez
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, F-75013, Paris, France. .,Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR_S 1136, F-75013, Paris, France. .,AP-HP, Hôpital Saint-Antoine, Service de Pharmacie, F-75012, Paris, France. .,Univ Paris-Sud, Faculté de Pharmacie, F-92296, Chatenay-Malabry, France.
| | - Eric Maury
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, F-75013, Paris, France. .,Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR_S 1136, F-75013, Paris, France. .,AP-HP, Hôpital Saint-Antoine, Service de Réanimation, F-75012, Paris, France.
| | - Bertrand Guidet
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, F-75013, Paris, France. .,Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR_S 1136, F-75013, Paris, France. .,AP-HP, Hôpital Saint-Antoine, Service de Réanimation, F-75012, Paris, France.
| | - Gilles Hejblum
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, F-75013, Paris, France. .,Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR_S 1136, F-75013, Paris, France. .,AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, F-75012, Paris, France.
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Abstract
OBJECTIVE To determine the point prevalence of drug-induced hypotension episodes in critically ill patients, to assess the episodes resulting from error, and to describe how episodes are treated. DESIGN Multicenter observational, 24-hour snapshot study. SETTING Forty-seven ICUs in 27 institutions located in the United States, Canada, and Singapore. PATIENTS A total of 688 ICU patients were evaluated. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients were included in the study if they had an episode of hypotension in the 24 hours prior to the clinical pharmacists' evaluation. The definition for a hypotensive episode is either a systolic blood pressure less than 90 mm Hg or a decrease in systolic blood pressure of 30 mm Hg over a 2-hour period. Each episode of unintentional hypotension was assessed for suspected drug-related causes. When a drug-related cause was suspected, an objective assessment tool, the modified Kramer, was used to determine causality. A score of at least "possible" was considered drug induced, referred to as a "drug-related hazardous condition." A drug-related hazardous condition is the temporal gap (intermediate stage) between the identification of an adverse drug reaction and the subsequent onset of drug-induced injury, known as an "adverse drug event." Drug-induced episodes were evaluated for medication errors and treatment. One hundred fifty-eight patients experienced 204 hypotensive episodes that were considered unintentional and drug related. Common drugs implicated included propofol, fentanyl, metoprolol, lorazepam, hydralazine, and furosemide. A total of 54 episodes (26.5%) resulted from medication errors. Common error types were improper dose/quantity (46%) and prescribing (25%). A total of 56.9% episodes were treated. CONCLUSIONS Many hypotensive episodes in the ICU are drug related and require treatment. A substantial portion of these episodes result from errors and are therefore preventable. This presents opportunities to improve prescribing including optimizing drug dosing to avoid possible patient harm from drug-induced hypotension.
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Belhekar MN, Taur SR, Munshi RP. A study of agreement between the Naranjo algorithm and WHO-UMC criteria for causality assessment of adverse drug reactions. Indian J Pharmacol 2014; 46:117-20. [PMID: 24550597 PMCID: PMC3912795 DOI: 10.4103/0253-7613.125192] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 08/24/2013] [Accepted: 11/27/2013] [Indexed: 11/25/2022] Open
Abstract
Objectives: Reliability and usefulness of various adverse drug reaction (ADR) causality assessment scales have not been fully explored. There is no universally accepted method for causality grading of ADRs. In the present study we assessed agreement between the two widely used causality assessment scales, that is, the World Health Organization-Uppsala Monitoring Center (WHO-UMC) criteria and the Naranjo algorithm. Materials and Methods: The same observer assessed all ADRs (n = 913) collected between January 2010 and December 2012 using the WHO-UMC criteria and Naranjo algorithm at a tertiary care hospital in India. We found that the most frequently assigned causality category was “possible” with both the scales. Results: A disagreement in the causality assessment was found in 45 (4.9%) cases reflecting “poor” agreement between the two scales (Kappa statistic with 95% confidence interval = 0.143 [0.018, 0.268]). The mean time taken to assess causality of the ADR using the WHO-UMC criteria was shorter than that by the Naranjo algorithm. Conclusion: This study showed that there is a poor agreement between the WHO-UMC criteria and Naranjo algorithm with the former being less time-consuming.
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Affiliation(s)
- Mahesh N Belhekar
- Department of Clinical Pharmacology, Topiwala National Medical College and Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai Central, Mumbai, Maharashtra, India
| | - Santosh R Taur
- Department of Clinical Pharmacology, Topiwala National Medical College and Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai Central, Mumbai, Maharashtra, India
| | - Renuka P Munshi
- Department of Clinical Pharmacology, Topiwala National Medical College and Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai Central, Mumbai, Maharashtra, India
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Kane-Gill S. Comment: Prevalence and Nature of Medication Administration Errors in Health Care Settings: A Systematic Review of Direct Observational Evidence. Ann Pharmacother 2013; 47:760-1. [DOI: 10.1345/aph.1r147a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sandra Kane-Gill
- Associate Professor of Pharmacy and Therapeutics, Critical Care Medicine, Department of Biomedical Informatics and Clinical Translational Sciences, University of Pittsburgh, Pittsburgh, PA, Critical Care Medication Safety Pharmacist, Department of Pharmacy, University of Pittsburgh Medical Center,
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25
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Kane-Gill SL, Kosmisky DE, Dasta JF, Pizzi LT, Toner R, Foley K, Thomson E, Chow W, Kim M, Couto J, Royo M, Viscusi E. Critically evaluating adverse drug events retrospectively for research: is there a standard? Pharmacotherapy 2012; 33:e143-4; discussion e144. [PMID: 23238985 DOI: 10.1002/phar.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sandra L Kane-Gill
- Center for Pharmacoinformatics and Outcomes Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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