Incidence and Costs of Adverse Drug Reactions in a Tertiary Care Pediatric Intensive Care Unit

Abstract

Adverse drug reactions (ADRs) increase morbidity, mortality, and hospital costs in children treated in the Pediatric Intensive Care Unit (PICU). Few studies have reported the incidence and risk factors of ADRs in PICU. Our study aimed to evaluate incidence, risk factors, and economic burden of ADRs in PICU. An intensive ADR surveillance was conducted at the PICU of Children's Hospital of Michigan between November 1, 2010 and May 31, 2011. A trigger list was used to screen for suspected ADR cases. Of the 697 consecutive PICU admissions reviewed, 13.1% experienced at least one episode of ADR. The ADR incidence was 22% in patients with cardiovascular (CV) surgery and 11.5% in other patients. The most frequently detected ADR was electrolyte imbalance associated with diuretic exposure. Mean age at admission was 4 years (interquartile range: 9 months-13 years). Risk factors for ADR included young age (<1 year), Pediatric Risk of Mortality (PRISM) score upon admission ≥3, and administration of ≥16 medications. ADRs increased total ICU costs by 3.5-fold and length of ICU stay by 3.8-fold. Increased ADR surveillance of high risk patients in conjunction with early intervention may reduce drug related morbidity and costs in the PICU.

Adverse drug events in pediatric intensive care are common, but improvement strategies exist and are effective

“…Already in a small sample of patients (n=53), the impact of the CPS on the detection of preventable ADE (n=141 events in 53 cases) was relevant. The most common interventions related to incompatibility of intravenous solutions (21%), or inadequate doses (17%) and-similar to other observations1 , 2 , 5-antimicrobial agents were overrepresented (5 of the top 10 drugs) in the intervention group.…”

“…Unfortunately, these off label practices are associated by significant higher risks to develop ADE. Du et al recently quantified this risk in a cohort of 697 consecutive PICU admissions 5. The overall risk was 13.1%, with an even higher risk after cardiovascular surgery, during infancy (<1 year of age), or in the setting of polypharmacy (≥6 drugs) or higher disease severity (Pediatric Risk of Mortality score upon admission) 5…”

Potential Drug−Drug Interactions in Infant, Child, and Adolescent Patients in Children’s Hospitals

“…2,8,18,19 At the same time, ADEs can result in significant morbidity and mortality. [20][21][22] Our findings therefore point to a central problem or tradeoff of warning systems, encapsulated by the story of the boy who cried wolf: the current compendiums of PDDIs suffer from identifying so many PDDIs that the signal of true potential patient harm may get lost in the noise of too many alarms. This situation is analogous to the growing concern that an overabundance of bedside patient monitors and their separate alarms does not necessarily improve patient safety.…”

A systematic review of observational studies evaluating costs of adverse drug reactions

“…The costs of ADEs related to any drug occurring in nonhospitalized patients has been estimated from €702.21 to €40,273.08 13,14,18–29. A study investigated the costs of ADEs related to rhythm-control, rate-control, and combined rhythm-/rate-control medication; the costs per patient with an ADE were estimated to be €2,737.46 21.…”

“…A study investigated the costs of ADEs related to rhythm-control, rate-control, and combined rhythm-/rate-control medication; the costs per patient with an ADE were estimated to be €2,737.46 21. Leendertse et al assessed the costs of ADEs in geriatric population whereas Du et al estimated the costs of ADEs in pediatric population 13,14. The incremental total cost per patient with an ADE was estimated as €6,527.37 and €40,273.08, respectively 13,14…”