Drug-related emergency department visits: external validation of an assessment tool in a general emergency department population.

Autor: Nymoen LD; Diakonhjemmet Hospital Pharmacy, Oslo, Norway., Pettersen JLS; Department of Pharmacy, University of Oslo, Oslo, Norway., Flatebø TE; Diakonhjemmet Hospital Pharmacy, Oslo, Norway., Øie E; Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway., Viktil KK; Diakonhjemmet Hospital Pharmacy, Oslo, Norway. kirstkv@farmasi.uio.no.; Department of Pharmacy, University of Oslo, Oslo, Norway. kirstkv@farmasi.uio.no.
Jazyk: angličtina
Zdroj: International journal of clinical pharmacy [Int J Clin Pharm] 2024 Dec; Vol. 46 (6), pp. 1327-1334. Date of Electronic Publication: 2024 Jul 03.
DOI: 10.1007/s11096-024-01760-8
Abstrakt: Background: The process of identifying drug-related hospitalisations is subjective and time-consuming. Assessment tool for identifying hospital admissions related to medications (AT-HARM10) was developed to simplify and objectify this process. AT-HARM10 has not previously been externally validated, thus the predictive precision of the tool is uncertain.
Aim: To externally validate AT-HARM10 in adult patients admitted to the emergency department (ED).
Method: This retrospective cross-sectional study investigated 402 patients admitted to the ED, Diakonhjemmet Hospital, Oslo, Norway. A trained 5th-year pharmacy student used AT-HARM10 to assess all patients and to classify their ED visits as possibly or unlikely drug-related. Assessment of the same patients by an interdisciplinary expert panel acted as the gold standard. The external validation was conducted by comparing AT-HARM10 classifications with the gold standard.
Results: According to AT-HARM10 assessments, 169 (42%) patients had a possible drug-related ED visit. Calculated sensitivity and specificity values were 95% and 71%, respectively. Further, positive and negative predictive values were 46% and 98%, respectively. Adverse effects/over-treatment and suboptimal treatment were the issues most frequently overestimated by AT-HARM10 compared with the gold standard.
Conclusion: AT-HARM10 identifies drug-related ED visits with high sensitivity. However, the low positive predictive value indicates that further review of ED visits classified as possible drug-related by AT-HARM10 is necessary. AT-HARM10 can serve as a useful first-step screening that efficiently identifies unlikely drug-related ED visits, thus only a smaller proportion of the patients need to be reviewed by an interdisciplinary expert panel.
Competing Interests: Conflicts of interest The authors have no conflict of interest to declare.
(© 2024. The Author(s).)
Databáze: MEDLINE
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