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Prediction of hospitalization due to adverse drug reactions in elderly community-dwelling patients (The PADR-EC Score)

Citation

Parameswaran Nair, N and Chalmers, L and Connolly, M and Bereznicki, BJ and Peterson, GM and Curtain, C and Castelino, RL and Bereznicki, LRE, Prediction of hospitalization due to adverse drug reactions in elderly community-dwelling patients (The PADR-EC Score), PLoS One, 11, (10) pp. 1-17. ISSN 1932-6203 (2016) [Refereed Article]


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Copyright Statement

Copyright: © 2016 Parameswaran Nair et al. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

DOI: doi:10.1371/journal.pone.0165757

Abstract

Background: Adverse drug reactions (ADRs) are the major cause of medication-related hospital admissions in older patients living in the community. This study aimed to develop and validate a score to predict ADR-related hospitalization in people aged ≥65 years.

Methods: AADR-related hospitalization and its risk factors were determined using a prospective, cross-sectional study in patients aged ≥ 65 years admitted to two hospitals. A predictive model was developed in the derivation cohort (n = 768) and the model was applied in the validation cohort (n = 240). ADR-related hospital admission was determined through expert consensus from comprehensive reviews of medical records and patient interviews. The causality and preventability of the ADR were assessed based on the Naranjo algorithm and modified Schumock and Thornton criteria, respectively.

Results: In the derivation sample (mean [± SD] age, 80.1 ± 7.7 years), 115 (15%) patients were admitted due to a definite or probable ADR; 92.2% of these admissions were deemed preventable. The number of antihypertensives was the strongest predictor of an ADR followed by presence of dementia, renal failure, drug changes in the preceding 3 months and use of anticholinergic medications; these variables were used to derive the ADR prediction score. The predictive ability of the score, assessed from calculation of the area under the receiver operator characteristic (ROC) curve, was 0.70 (95% confidence interval (CI) 0.65–0.75). In the validation sample (mean [± SD] age, 79.6 ± 7.6 years), 30 (12.5%) patients’ admissions were related to definite or probable ADRs; 80% of these admissions were deemed preventable. The area under the ROC curve in this sample was 0.67 (95% CI 0.56–0.78).

Conclusions: This study proposes a practical and simple tool to identify elderly patients who are at an increased risk of preventable ADR-related hospital admission. Further refinement and testing of this tool is necessary to implement the score in clinical practice.

Item Details

Item Type:Refereed Article
Keywords:ADR, adverse effect, risk, hospitalisation
Research Division:Medical and Health Sciences
Research Group:Pharmacology and Pharmaceutical Sciences
Research Field:Clinical Pharmacy and Pharmacy Practice
Objective Division:Health
Objective Group:Other Health
Objective Field:Health not elsewhere classified
Author:Parameswaran Nair, N (Mr Nibu Parameswaran Nair)
Author:Chalmers, L (Dr Leanne Chalmers)
Author:Connolly, M (Mr Michael Connolly)
Author:Bereznicki, BJ (Dr Bonnie Bereznicki)
Author:Peterson, GM (Professor Gregory Peterson)
Author:Curtain, C (Mr Colin Curtain)
Author:Castelino, RL (Dr Ronald Castelino)
Author:Bereznicki, LRE (Professor Luke Bereznicki)
ID Code:112265
Year Published:2016
Web of Science® Times Cited:9
Deposited By:Pharmacy
Deposited On:2016-11-01
Last Modified:2017-11-02
Downloads:60 View Download Statistics

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