Medications for Children Receiving Intensive Care: A National Sample

Abstract

Objective: To examine medication administration records through electronic health record data to provide a broad description of the pharmaceutical exposure of critically ill children. Design: Retrospective cohort study using the Cerner Health Facts database. Setting: United States. Patients: A total of 43,374 children 7 days old to less than 22 years old receiving intensive care with available pharmacy data. Interventions: None. Measurements and Main Results: A total of 907,440 courses of 1,080 unique medications were prescribed with a median of nine medications (range, 1–99; 25–75th percentile, 5–16) per patient. The most common medications were acetaminophen, ondansetron, and morphine. Only 45 medications (4.2%) were prescribed to more than 5% of patients, and these accounted for 442,067 (48.7%) of the total courses of medications. Each additional medication was associated with increased univariate risk of mortality (odds ratio, 1.05; 95% CI, 1.05–1.06; p < 0.001). Conclusions: Children receiving intensive care receive a median of nine medications per patient and one quarter are prescribed at least than 16 medications. Only 45 medications were prescribed to more than 5% of patients, but these accounted for almost half of all medication courses.

Dynamic Mortality Risk Predictions for Children in ICUs: Development and Validation of Machine Learning Models*

“…First, we used a retrospective EHR dataset. While we have used this dataset for multiple pediatric analyses (5–7, 15, 16), prospective data collection could add additional data elements. Second, a more extensive exploration of machine learning methods might have uncovered better performing models.…”

“…Not all data are available for all admissions. Health Facts (Cerner Corporation) is representative of the United States (13) and used in previous care assessments, including the Acute Physiology and Chronic Health Evaluation score (14), the Criticality Index (5–7), and pediatric medication use (15, 16).…”

The Association of the Lactate-Albumin Ratio With Mortality and Multiple Organ Dysfunction in PICU Patients*

“…Cerner Corporation has established HIPAA compliance operating policies to establish de-identification of Health Facts. Health Facts has been assessed as representative of the United States (24) and used in previous care assessments, including the Acute Physiology and Chronic Health Evaluation score (25), the Criticality Index (26, 27), and medication use practice patterns for children in ICUs (28, 29). Details on data cleaning and definitions, medication classification, and diagnostic classifications have been published (26, 27, 30).…”

Association of Intravenous Acetaminophen Administration With the Duration of Intravenous Opioid Use Among Hospitalized Pediatric Patients

“… 24 , 25 , 26 , 27 The database has been used to study multiple aspects of pediatrics and pediatric medication practices. 1 , 3 , 28 , 29 , 30 , 31 eAppendix 1 in the Supplement provides a detailed description of the data cleaning process, definitions, and hospital characteristics.…”

“…The database is representative of the US and inclusive of academic and nonacademic hospitals of varied sizes and locations, making it appropriate for comparative effectiveness research that is generalizable . The database has been used to study multiple aspects of pediatrics and pediatric medication practices . eAppendix 1 in the Supplement provides a detailed description of the data cleaning process, definitions, and hospital characteristics.…”