Patient-specific risk factors of adverse drug events in adult inpatients - evidence detected using the Global Trigger Tool method

Study Design: Systematic review. Objectives: Osteoporosis is one of the most common diseases of the elderly, whereby vertebral body fractures are in many cases the first manifestation. Even today, the consequences for patients are underestimated. Therefore, early identification of therapy failures is essential. In this context, the aim of the present systematic review was to evaluate the current literature with respect to clinical and radiographic findings that might predict treatment failure. Methods: We conducted a comprehensive, systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist and algorithm. Results: After the literature search, 724 potentially eligible investigations were identified. In total, 24 studies with 3044 participants and a mean follow-up of 11 months (range 6-27.5 months) were included. Patient-specific risk factors were age >73 years, bone mineral density with a t-score <−2.95, BMI >23 and a modified frailty index >2.5. The following radiological and fracture-specific risk factors could be identified: involvement of the posterior wall, initial height loss, midportion type fracture, development of an intravertebral cleft, fracture at the thoracolumbar junction, fracture involvement of both endplates, different morphological types of fractures, and specific MRI findings. Further, a correlation between sagittal spinal imbalance and treatment failure could be demonstrated. Conclusion: In conclusion, this systematic review identified various factors that predict treatment failure in conservatively treated osteoporotic fractures. In these cases, additional treatment options and surgical treatment strategies should be considered in addition to follow-up examinations.

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Establishment of a pediatric trigger tool based on Global Trigger Tool to identify adverse drug events of children: experience in a Chinese hospital

BMC Pediatrics ◽

10.1186/s12887-020-02354-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yi Liu ◽

Junfeng Yan ◽

Yunfei Xie ◽

Yuan Bian

Keyword(s):

Cohort Study ◽

Retrospective Review ◽

Retrospective Cohort ◽

Literature Search ◽

Adverse Drug Events ◽

Trigger Tool ◽

Trigger Rate ◽

Global Trigger Tool ◽

Pediatric Inpatient ◽

Grade 3

Abstract Background The Global Trigger Tool (GTT),which is a method using “triggers” to review medical record retrospectively to identify possible adverse events. Several studies showed that the GTT was effective. However, there were only a few localized trigger tools that had been established to detect pediatric adverse drug events (ADEs) in China. This study aimed to establish a pediatric trigger tool based on GTT, to examine the performance by detecting pediatric inpatients ADEs in a Chinese hospital (a retrospective review), and to investigate the factors associating with the occurrence of ADEs. Methods The triggers were established by three steps including literature search, triggers extraction and revision, and experts investigation. A retrospective cohort study was conducted to detect ADEs by using 200 pediatric inpatient records of Sichuan Provincial People’s Hospital. Results Thirty-three preliminary triggers were established, and 2 rounds of experts investigation were conducted. Finally, 33 triggers were established. In the retrospective review, the positive trigger rate was 64.0%, while the positive predictive value (PPV) was 24.9%. The occurrence of inpatients with ADEs was 20.5%. ADEs/100 admissions were 49.0. ADEs/1000 patient days were 46.89. The most common ADE categories were leukocyte disorders, skin disorders and platelet disorders. The severity of 39 ADEs was grade 1, 55 ADEs was grade 2, 4 ADEs was grade 3. The highest frequency of ADE-related drugs was antineoplastic, followed by antibacterial. The length of stay and the leukemia in the diagnosed diseases were positively correlated with ADEs. Conclusions The 33 pediatric triggers may detect ADEs effectively, but still need to be optimized. This study may provide some references for further research in order to improve the rationality and safety of medication.

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Risk Factors for Adverse Drug Events: A 10-Year Analysis

Annals of Pharmacotherapy ◽

10.1345/aph.1e642 ◽

2005 ◽

Vol 39 (7-8) ◽

pp. 1161-1168 ◽

Cited By ~ 88

Author(s):

R Scott Evans ◽

James F Lloyd ◽

Gregory J Stoddard ◽

Jonathan R Nebeker ◽

Matthew H Samore

Keyword(s):

Risk Factors ◽

Creatinine Clearance ◽

Drug Administration ◽

Adverse Drug Events ◽

Conditional Logistic Regression ◽

Patient Characteristics ◽

Patient Specific ◽

Administration Route ◽

Odds Ratios ◽

Tertiary Teaching

BACKGROUND Many adverse drug events (ADEs) are the result of known pharmacologic properties, and some result from medication errors. However, some are the result of patient-specific risk factors. OBJECTIVE To identify inpatient risk factors for ADEs. METHODS Conditional logistic regression was used to analyze all pharmacist-verified ADEs by therapeutic class of drugs and severity during a 10-year study period. All inpatients ≥18 years of age from a 520-bed tertiary teaching hospital were included. Each case patient was matched with up to 16 control patients. Odds ratios for patient factors associated with ADEs were calculated from different therapeutic classes of drugs. RESULTS Odds ratios for numerous risk factors were identified for 4376 ADEs and were found to vary depending on therapeutic classification. The risk factors for the different classifications were grouped by (1) patient characteristics—female (OR 1.5–1.7), age (0.7–0.9), weight (1.2–1.4), creatinine clearance (0.8–4.7), and number of comorbidities (1.1–12.6); (2) drug administration—dosage (1.2–3.7), administration route (1.4–149.9), and number of concomitant drugs (1.2–2.4); and (3) patient type—service (1.2–4.9), nursing division (1.5–3.8), and diagnosis-related group (1.5–5.7). CONCLUSIONS Some risk factors are consistent for all ADEs and across multiple therapeutic classes of drugs, while others are class specific. High-risk agents should be closely monitored based on patient characteristics (gender, age, weight, creatinine clearance, number of comorbidities) and drug administration (dosage, administration route, number of concomitant drugs).

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Gender as a Predictor of Complications in Endoscopic Sinus Surgery

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420987418 ◽

2021 ◽

pp. 000348942098741

Author(s):

Rahul K. Sharma ◽

Sonam Dodhia ◽

Justin S. Golub ◽

Jonathan B. Overdevest ◽

David A. Gudis

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Endoscopic Sinus Surgery ◽

Lower Risk ◽

Sinus Surgery ◽

Smoking History ◽

Patient Specific ◽

Specific Risk ◽

Operative Complications ◽

Post Operative Complications

Background: Understanding patient-specific risk factors for complications of functional endoscopic sinus surgery (ESS) is critical. Previous work has investigated such risk factors, but a population-based analysis has not been performed to date. Objectives: This study analyzes the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patient-specific risk factors associated with complications following ESS. Methods: A retrospective cohort study of patients who underwent ESS was conducted using the NSQIP database from 2011 to 2017. Patients were identified using CPT-codes for ESS procedures. The primary outcome analyzed was any postoperative complication. Simultaneous procedures with ESS were controlled for with regression analysis. Post-operative complications and 30-day readmission were evaluated using multivariate logistic regression controlling for age, gender, race, comorbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, congestive heart failure, renal failure, steroid use, and cancer history), smoking history, and intraoperative factors. Results: A total of 1279 patients who underwent ESS were identified. The average age of patients was 46.1 (SD = 16.8). Most patients (58.2%) had no major comorbidities. 594 (46.4%) patients had a tonsillectomy, adenoidectomy, or uvulopharyngoplasty at the same time as ESS. 101 (7.9%) patients experienced a complication post-operatively. 46 (3.6%) patients experienced a readmission postoperatively. The most common complication was reoperation (N = 40, 3.1%). Regression analysis revealed that gender was the only demographic factor associated with risk of post-operative complications, with women having a significantly lower risk than men (OR = 0.61, 95% CI 0.37-0.99, P = .046). Conclusions: ESS is typically performed on a relatively young and healthy population. Women have a significantly lower risk of complications after controlling for comorbidities. Further analysis of gender-specific differences in surgical outcomes should be evaluated to understand this phenomenon.

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Patient‐specific risk factors for positioning injuries

AORN Journal ◽

10.1002/aorn.13384 ◽

2021 ◽

Vol 113 (4) ◽

Keyword(s):

Risk Factors ◽

Patient Specific ◽

Specific Risk

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MP50-20 PATIENT-SPECIFIC RISK FACTORS AND POST-OPERATIVE COMPLICATIONS HAVE A SIGNIFICANT IMPACT ON LONG TERM FUNCTIONAL OUTCOMES FOLLOWING RADICAL PROSTATECTOMY

The Journal of Urology ◽

10.1097/ju.0000000000002076.20 ◽

2021 ◽

Vol 206 (Supplement 3) ◽

Author(s):

Nicholas Raison ◽

Gledisa Musollari ◽

Kathy Man ◽

Natasha Bhate ◽

Joanne Sethi ◽

...

Keyword(s):

Risk Factors ◽

Radical Prostatectomy ◽

Functional Outcomes ◽

Patient Specific ◽

Specific Risk ◽

Operative Complications ◽

Post Operative Complications

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Establishment of a Pediatric Trigger Tool Based on Global Trigger Tool to Identify Adverse Drug Events of Children: Experience in a Chinese hospital

10.21203/rs.3.rs-24648/v1 ◽

2020 ◽

Author(s):

YI LIU ◽

JUN FENG YAN ◽

YUN FEI XIE ◽

YUAN BIAN

Keyword(s):

Retrospective Review ◽

Retrospective Cohort ◽

Literature Search ◽

Adverse Drug Events ◽

Skin Lesions ◽

Trigger Tool ◽

Trigger Rate ◽

Global Trigger Tool ◽

Pediatric Inpatient ◽

Grade 3

Abstract Background: The Global Trigger Tool (GTT)，which is a method using “triggers” to review medical record retrospectively to identify possible adverse events. Several studies showed that the GTT was effective. However, there were only a few localized trigger tools that had been established to detect pediatric adverse drug events (ADEs) in China. This study aimed to establish a pediatric trigger tool based on GTT, to examine the performance by detecting pediatric inpatients ADEs in a Chinese hospital (a retrospective review), and to investigate the factors associating with the occurrence of ADEs. Methods: The triggers were established by three steps including literature search, triggers extraction and revision, and experts investigation. A retrospective cohort study was conducted to detect ADEs by using 200 pediatric inpatient records of Sichuan Provincial People's Hospital. Results: 33 preliminary triggers were established, and 2 rounds of experts investigation were conducted. Finally, 33 triggers were established. In the retrospective review, the positive trigger rate was 64.0%, while the positive predictive value (PPV) was 24.9%. The occurrence of inpatients with ADEs was 20.5%. ADEs/100 patients were 49.0. ADEs/1000 patients days were 46.89. The most common ADE categories were leukocyte abnormalities, skin lesions and platelet abnormalities. The severity of 39 ADEs was grade 1, 55 ADEs was grade 2, 4 ADEs was grade 3. The highest frequency of ADE-related drugs was antineoplastic, followed by antibacterial. The length of stay and the leukemia in the diagnosed diseases were positively correlated with ADEs . Conclusion : The 33 pediatric triggers may detect ADEs effectively, but still need to be optimized. This study may provide some references for further research in order to improve the rationality and safety of medication.

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Risk Factors for Antibiotic Resistant Urinary Pathogens in Patients Discharged From the Emergency Department

Hospital Pharmacy ◽

10.1177/00185787211046851 ◽

2021 ◽

pp. 001857872110468

Author(s):

Stephanie L. Barré ◽

Erin R. Weeda ◽

Andrew J. Matuskowitz ◽

Gregory A. Hall ◽

Kyle A. Weant

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Antibiotic Resistance ◽

Urinary Tract ◽

Antibiotic Use ◽

Patient Specific ◽

Lifetime History ◽

Specific Risk ◽

History Of ◽

Inappropriate Antibiotics

Purpose: Urinary tract infections (UTIs) are one of the most common indications for antimicrobial use in the emergency department (ED). Appropriate empiric selection is crucial to ensure optimal care while limiting broad-spectrum antibiotic use. The primary objective of this study was to evaluate the relationship between patient-specific risk factors and drug resistant urinary pathogens in patients discharged from the ED and followed by Emergency Medicine Pharmacists (EMPs). Methods: This was a single-center, retrospective chart review of adult (≥18 years old) patients with positive urine cultures discharged from the ED. The association between risk factors and pathogen resistance to ≥1 classes of antibiotics was evaluated using multivariate logistic regression. Risk factors included the following: hospitalization within the previous 30 days, intravenous antibiotic use within 90 days, diabetes, clinical atherosclerotic cardiovascular disease, psychiatric disorder, dementia, current antibiotic use for any indication, previous lifetime history of UTIs, indwelling or intermittent catheterization, hemodialysis, previous lifetime history of a urologic procedure, urinary tract abnormality, immunosuppressive disease or medications, current residence in a nursing or rehabilitation facility, and history of a multidrug resistant organism (MDRO). Results: A total of 1018 patients were included. There was an increase in the odds of antibiotic resistance in patients with cystitis and ≥2 risk factors (Odds Ratio [OR] = 1.70, 95% CI = 1.24-2.32). In those with pyelonephritis, there was a non-significant increase in the odds of resistance for those with ≥2 risk factors (OR = 1.83, 95% CI = 0.98-3.42). Patients with pyelonephritis discharged on inappropriate antibiotics were more likely to return to the ED within 30 days ( P = .03). Conclusions: For patients with cystitis discharged from the ED, those with ≥2 patient-specific risk factors had significantly increased odds of antibiotic resistance. Patients with pyelonephritis, but not cystitis, who were discharged on inappropriate antibiotics were more likely to return to the ED within 30 days. In conjunction with an EMP culture follow-up program, the identification of risk factors for antimicrobial resistance can be used to design more patient-specific empiric antibiotic selections.

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