Prediction of Hospitalization due to Adverse Drug Reactions in Elderly Community-Dwelling Patients (The PADR-EC Score).

Nibu Parameswaran Nair,Bonnie J Bereznicki,Leanne Chalmers,Michael Connolly,Luke R Bereznicki,Ronald L Castelino,Gregory M Peterson,Colin Curtain,Alessandra Marengoni

doi:10.1371/journal.pone.0165757

Nibu Parameswaran Nair, Bonnie J Bereznicki + Show 7 more

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https://doi.org/10.1371/journal.pone.0165757

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Journal: PloS one	Publication Date: Oct 31, 2016
Citations: 55	License type: CC BY 4.0

Affiliation: University of Tasmania, Royal Hobart Hospital

Abstract

BackgroundAdverse 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.MethodsADR-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.ResultsIn 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).ConclusionsThis 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.

Highlights

Advancing age contributes to increased drug usage in older patients, which in turn is associated with an increased risk of adverse drug reactions (ADRs), causing significant morbidity and mortality [1]
This study proposes a practical and simple tool to identify elderly patients who are at an increased risk of preventable ADR-related hospital admission
Most of the ADR-related hospitalizations were considered preventable (106, 92.2%) and all ADRs were classified as Type A reactions except one which was considered as a Type B reaction

Summary

Introduction

Advancing age contributes to increased drug usage in older patients, which in turn is associated with an increased risk of adverse drug reactions (ADRs), causing significant morbidity and mortality [1]. The prevalence of ADRs in older outpatient clinic attendees ranges from 5–35% [2, 3]. ADRs are one of the main reasons for hospitalization in older patients living in the community [4]. The proportion of all hospital admissions due to ADRs has ranged from 6–12% among older patients [1, 4,5,6,7]. 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

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