Adverse drug events in Chinese pediatric inpatients and associated risk factors: a retrospective review using the Global Trigger Tool

Huan-huan Ji, Lin Song, Jian-wen Xiao, Yu-xia Guo, Ping Wei, Ting-ting Tang, Xiao-jiang Tian, Xue-wen Tang, Yun-tao Jia
<span title="2018-02-07">2018</span> <i title="Springer Nature"> <a target="_blank" rel="noopener" href="https://fatcat.wiki/container/tnqhc2x2aneavcd3gx5h7mswhm" style="color: black;">Scientific Reports</a> </i> &nbsp;
Understanding the epidemiology and risk factors of adverse drug events (ADEs) in pediatric inpatient is essential if we are to prevent, reduce or ameliorate the harm experienced. The Global Trigger Tool (GTT) is a method of retrospective medical record review that measures harm in hospitalized children. We employed a three-stage retrospective chart review of random samples of 1800 pediatric inpatients discharged from January 2013 to December 2015. 31 kinds of pediatric-specific triggers were
more &raquo; ... e based on the previous trigger tool studies developed for use in adult or pediatric. Positive predictive value (PPV) of individual triggers, as well as ADEs detection rates were calculated. Stepwise logistic regression was performed to investigate risk factors associated with ADEs. Of 1746 patients, detected in 221 patients (12.7%) with 247 ADEs. The PPV of the trigger tool was 13.3%. Of the 247 ADEs, 82.6% were identified as category E, 11.7% category F and 5.7% category H. The pediatric-focused trigger tool is a feasible and useful tool for detecting pediatric ADEs. Especially for patients who have had more drugs, more doses or more admissions which needs to be closely monitored as triggers to improve the safety. Adverse drug events (ADEs) are defined by the Institute of Medicine (IOM) as injuries resulting from a medical intervention related to a drug and can manifest as signs, symptoms or laboratory abnormalities 1 . This is more general definition than that provided by the World Health Organization, which defined an adverse drug reaction (ADR) as a response to a drug, which is noxious and unintended, and occurs at doses normally used in man for prophylaxis, diagnosis or therapy of disease, or for the modification of physiologic function 2 . Because this definition of ADR excludes overdose, drug abuse and treatment failure and drug administration errors. An adverse event was defined as any injury (not just that associated with medication or drug use) caused by medical management rather than by the underlying disease or condition of the patient 3 . We only concerned with medication associated adverse events, such as ADR and drug administration errors. ADEs are important causes of iatrogenic morbidity and mortality, especially for children, but the frequency of ADEs is unknown. The reported rates of ADEs range from 0.6% to 20% 4,5 , due to the differences in definitions of ADEs, methods, prescribing habits, age group, and clinical settings. Traditional methods to detect ADEs have focused on voluntary reporting. However, public health researchers have established that on average only 10-20% of errors are ever reported and of those, 90-95% cause no harm to patients 6 . The Global Trigger Tool (GTT) developed by the Institute for Healthcare Improvement (IHI) is a retrospective review of a random sample of inpatient hospital records using "trigger" to identify possible adverse events 6 . The GTT, which requires minimal training, appears to increase the rate of ADE detection 50-fold from traditional reporting methods 7 . Using the GTT, Classen et al. found at least ten times
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