An investigation into the avoidability of adverse drug reactions using the LAAT and modified Hallas tools

Abstract

An adverse drug reactions avoidability tool called the Liverpool ADR avoidability assessment tool (LAAT) was recently developed (for research purposes), and subsequently validated with mixed interrater reliability (IRR). We investigated the comparative IRR of this tool in an inpatient cohort to ascertain its practical application in this setting. The patient population was comprised of 44 ADR drug pairs drawn from an observational prospective cohort of patents with ADR attending a Weill Cornell Medicine-affiliated tertiary medical Centre in Doha Qatar (Hamad General Hospital). Using the LAAT, and modified Hallas tools, 4 independent raters (2 Clinical Pharmacologists, and 2 General Physicians) assessed and scored the 44 ADR-drug pairs. Agreement proportions between the rating pairs were evaluated as well individual/overall kappa statistics and intraclass correlation coefficients. We evaluated the weight of each of the 7 questions on the LAAT tool to ascertain its determinative role. Across 44 ADR-drug pairs, the overall median Fleiss kappa using the LAAT, and modified Hallas tools were 0.67 (interquartile range (IQR) 0.55, 0.76), 0.36 (IQR, 0.23–0.71) respectively. The overall percentage pairwise agreement with the LAAT and modified Hallas tools were 78.5%, and 62.2% respectively. Exact pairwise agreement occurred in 37 out of 44 (range 0.71–1), and 27 of 44 (0.53–0.77) ADR-drug pairs using the LAAT and modified Hallas tools respectively. Using the LAAT tool, the overall intraclass correlation coefficient was 0.68 (CI 0.55, 0.79), and 0.37 (CI 0.22, 0.53) with the modified Hallas tool. We report a higher proportion of “possible” and “definite” avoidability outcomes of adverse drug reactions compared with the modified Hallas, or that reported by developers of the LAAT tool. Although initially developed for research purposes, our report has suggested for the first time a potential applicability of this tool in clinical environment as well.

Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score

“…This is supported by moderate interrater reliability (IRR) of between 0.4 and 0.65. The interrater agreement and consistency among raters reported from our study is in agreement with findings from recently published reports that examined the utility of the novel LAAT tool in the general patient population [ 7 , 9 ]. The result of this study demonstrates the potential for preventability of costly and mortality-prone drug-related liver injury in vulnerable elderly population especially those with multi-morbidity, although this needs to be confirmed in by prospective systematic studies.…”

“…Our result suggests that this was not the case. The percentage of EA from our study (80%) is consistent with that reported by the original developers of the tool [9], and a recent study by Danjuma et al [7]. In the study by Danjuma et al [7], the percentage pairwise agreement utilizing the LAAT and modified Hallas tools were reported as 78.5% and 62.2% respectively.…”

“…The differences in our study population (elderly) compared to the patient population from which the LAAT tool was developed (pediatric oncology patients) appeared not to impact significantly on its performance. It has been argued that the relative preponderance of neutropenic patients in the study by Bracken et al [9] may have "rail-roaded" a proportion of the ADR cases to be rated as "not avoidable" [7,9]. We found no significant concerns regarding the disposition of "not avoidable" outcomes in our study.…”

“…Determining DILI drug classes that are potentially avoidable in the elderly will assist in rational therapeutic decision making, therapeutic commissioning, as well as the design of preventive measures aimed at reducing them [7]. In the general population, the modified Hallas [8] and more recently the validated Liverpool adverse drug reactions avoidability tool (LAAT) have increasingly been utilized in the determination of preventability of adverse drug reactions [7,9]. Despite the rising burden of DILI-related morbidities in the elderly population, the concept of its prevention through formal systematic analyses have gone unexamined until now.…”

QTc evaluation in COVID‐19 patients treated with chloroquine/hydroxychloroquine: A letter to the editor

“…1 Indeed, we recently reported on the utility of a novel tool (Liverpool Adverse Drug Reactions Avoidability tool [LAAT]) for identifying whether an adverse drug reaction (ADR) was avoidable or not. 3 This tool utilizes commonly recordable clinical parameters to adjudicate the preventability of development of adverse drug reactions. 4 Our comparative evaluation of the utility of this tool showed that its overall inter-rater agreement was >65% with an intraclass correlation coefficient of 0.68 (CI 0.55, 0.79).…”