Adverse Drug Event Prevention and Detection in Older Emergency Department Patients

Koehl, Jennifer L.

doi:10.1016/j.cger.2023.04.008

Cited by 3 publications

(1 citation statement)

References 38 publications

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“…Clinicians can utilize this information to create more successful preventative plans and gain a better understanding of how ADEs occur. Furthermore, the authors of [15] highlighted the importance of using interactive support tools to reduce the number of ADEs and prevent unnecessary prescribing cascades in older adults. Instead of just predicting whether ADEs will occur in cancer patients, the authors of [16] attempted to develop a new method for timing ADEs.…”

Section: Related Workmentioning

confidence: 99%

Layer-Weighted Attention and Ascending Feature Selection: An Approach for Seriousness Level Prediction Using the FDA Adverse Event Reporting System

Aldughayfiq,

Allahem,

Mostafa

et al. 2024

Applied Sciences

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In this study, we introduce a novel combination of layer-static-weighted attention and ascending feature selection techniques to predict the seriousness level of adverse drug events using the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). We utilized natural language processing (NLP) to analyze the terms in the active substance field, in addition to considering demographic and event information such as patient sex, healthcare provider qualification, and drug characterization. Our ascending feature selection method, which progressively incorporates additional features based on their importance, demonstrated continuous enhancements in prediction performance. Simultaneously, we employed a layer-static-weighted attention technique, which dynamically adjusts the model’s focus between natural language processing (NLP) and demographic features. This technique achieved its best performance at a balanced weight of 50%, yielding an average test accuracy of 74.56% and CV ROC score of 0.83 when 4000 features were included, indicating a compelling advantage to include a larger volume of meaningful features. By integrating these methodologies, we constructed a robust model capable of effectively predicting seriousness levels, offering significant potential for improving pharmacovigilance and enhancing drug safety monitoring. The results underscore the value of NLP and demographic data in predicting drug event seriousness and demonstrate the effectiveness of our combined techniques. We encourage further research to refine these methods and evaluate their application to other clinical datasets.

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Section: Related Workmentioning

confidence: 99%

Layer-Weighted Attention and Ascending Feature Selection: An Approach for Seriousness Level Prediction Using the FDA Adverse Event Reporting System

Aldughayfiq,

Allahem,

Mostafa

et al. 2024

Applied Sciences

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Pharmacogenomic Drug-Gene Interactions in Geriatric Emergency Department Patients That Have Fallen

Shih,

Engstrom,

Pandya

et al. 2024

Preprint

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Background: Pharmacogenomic assisted prescribing of medications utilizes individual genetic information to identify drug-gene interactions. We aimed to assess potential pharmacogenomic drug-gene interactions in geriatric emergency department (ED) patients that have sustained a fall. Methods: This was a prospective study involving 25 older adult ED patients with fall related injury. Data collected included current medications, demographics and mechanism of injury. All patients provided a DNA sample for pharmacogenomic testing, MatchMyMeds (DNA Labs, Boca Raton, FL) which assessed genetic data for 23 enzyme systems and reports on potential drug-gene interactions for 134 medications. Each patients medications were reviewed against their pharmacogenomic report and categorized as Green (go), Yellow (caution) or Red (stop) based on their genetic information and published interactions by the Clinical Pharmacogenetics Implementation Consortium (CPIC), Dutch Pharmacogenetics Working Group (DPWG) and Food and Drug Administration-approved drug label information. The main study outcome was pharmacogenomic drug-gene interactions. Results: Of the 25 patients enrolled (median age, 81 years, IQR: 76-85), 68% were female. Patients were taking a median of 8 medications (IQR: 5-11). The most common types were antihypertensives, statins, anticoagulants, and anti-platelet medications. Significant drug-gene interactions (Yellow or Red) were identified in 14/25 (56%) patients. Further, 6/25 (24%) had one or more potentially serious (Red) interactions identified. Conclusions: In geriatric ED patients with a fall-related injury, a majority have a significant pharmacogenomic drug-gene interactions. DNA testing identifies these interactions and can assist with pharmacogenomic-guided medication prescribing which may decrease ADEs and improve clinical outcomes.

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Short-Term Adverse Outcomes Related to Medication Use in Older Adults Visiting Emergency Department – a Retrospective Observational Study

Holstein,

Hongisto,

Jämsen

et al. 2024

Preprint

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Background. Drug-related emergency department (ED) visits are often encountered in the ED but remain unidentified, especially among older adults. Although medication use should be screened in the ED, little is known about their effect on short-term adverse ED outcomes. Therefore, we aimed to determine the association between polypharmacy and potentially inappropriate medication (PIM) use and short-term adverse outcomes in older ED patients. Methods. We retrospectively determined prescribed medications of 392 non-urgently transported community-dwelling patients aged ≥ 75 years. We measured polypharmacy and PIM use with dichotomous and ordinal variables. Comorbidities were assessed with Charlson Comorbidity Index (CCI). Primary outcomes were 90-day mortality, hospital admissions and 90-day ED revisits. Statistically, we used adjusted logistic regression analysis. Results. 80% of the patients had polypharmacy (≥ 5 regular medications) and 30% had excessive polypharmacy (≥ 10 regular medications). Polypharmacy did not predict higher risk of any study outcomes but was associated with a lower risk of 90-day mortality [adjusted OR 0.17 (95% CI 0.06–0.45), p < 0.001]. Excessive polypharmacy predicted a higher risk of 90-day ED revisits [adjusted OR 1.35 (95% CI 1.12–4.93), p = 0.024]. An increasing number of regular medications was associated with a higher risk of 90-day ED revisits [OR 1.09 (95% CI 1.03–1.16), p = 0.014] and a lower risk of 90-day mortality [OR 0.83 (95% CI 0.72–0.94, p = 0.005]. PIM use did not increase risks for any study outcomes. Increasing CCI predicted higher 90-day mortality rates [OR 1.70 (95% CI 1.37–2.10), p < 0.001]. Conclusions. Polypharmacy, defined as use of five or more medications is common among older ED patients but does not increase the risk of short-term adverse outcomes. Rising number of regular medications and excessive polypharmacy increases the risk for 90-day ED revisits. Instead of assessing polypharmacy with currently used numerical thresholds, EDs should screen excessive polypharmacy or use novel numerical thresholds to screen high-risk patients.

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Adverse Drug Event Prevention and Detection in Older Emergency Department Patients

Cited by 3 publications

References 38 publications

Layer-Weighted Attention and Ascending Feature Selection: An Approach for Seriousness Level Prediction Using the FDA Adverse Event Reporting System

Layer-Weighted Attention and Ascending Feature Selection: An Approach for Seriousness Level Prediction Using the FDA Adverse Event Reporting System

Pharmacogenomic Drug-Gene Interactions in Geriatric Emergency Department Patients That Have Fallen

Short-Term Adverse Outcomes Related to Medication Use in Older Adults Visiting Emergency Department – a Retrospective Observational Study

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