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Adverse drug reactions in children--a systematic review.

Smyth RM, Gargon E, Kirkham J, Cresswell L, Golder S, Smyth R, Williamson P - PLoS ONE (2012)

Bottom Line: Anti-infectives and anti-epileptics were the most frequently reported therapeutic class associated with ADRs in children admitted to hospital (17 studies; 12 studies respectively) and children in hospital (24 studies; 14 studies respectively), while anti-infectives and non-steroidal anti-inflammatory drugs (NSAIDs) were frequently reported as associated with ADRs in outpatient children (13 studies; 6 studies respectively).Fourteen studies reported rates ranging from 7%-98% of ADRs being either definitely/possibly avoidable.Although these studies provide estimates of incidence in different settings and some indication of the therapeutic classes most frequently associated with ADRs, further work is needed to address how such ADRs may be prevented.

View Article: PubMed Central - PubMed

Affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, England, United Kingdom. rebecca.smyth@manchester.ac.uk

ABSTRACT

Background: Adverse drug reactions in children are an important public health problem. We have undertaken a systematic review of observational studies in children in three settings: causing admission to hospital, occurring during hospital stay and occurring in the community. We were particularly interested in understanding how ADRs might be better detected, assessed and avoided.

Methods and findings: We searched nineteen electronic databases using a comprehensive search strategy. In total, 102 studies were included. The primary outcome was any clinical event described as an adverse drug reaction to one or more drugs. Additional information relating to the ADR was collected: associated drug classification; clinical presentation; associated risk factors; methods used for assessing causality, severity, and avoidability. Seventy one percent (72/102) of studies assessed causality, and thirty four percent (34/102) performed a severity assessment. Only nineteen studies (19%) assessed avoidability. Incidence rates for ADRs causing hospital admission ranged from 0.4% to 10.3% of all children (pooled estimate of 2.9% (2.6%, 3.1%)) and from 0.6% to 16.8% of all children exposed to a drug during hospital stay. Anti-infectives and anti-epileptics were the most frequently reported therapeutic class associated with ADRs in children admitted to hospital (17 studies; 12 studies respectively) and children in hospital (24 studies; 14 studies respectively), while anti-infectives and non-steroidal anti-inflammatory drugs (NSAIDs) were frequently reported as associated with ADRs in outpatient children (13 studies; 6 studies respectively). Fourteen studies reported rates ranging from 7%-98% of ADRs being either definitely/possibly avoidable.

Conclusions: There is extensive literature which investigates ADRs in children. Although these studies provide estimates of incidence in different settings and some indication of the therapeutic classes most frequently associated with ADRs, further work is needed to address how such ADRs may be prevented.

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Related in: MedlinePlus

What proportion of all paediatric hospital admissions are ADR related?
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pone-0024061-g001: What proportion of all paediatric hospital admissions are ADR related?

Mentions: We do not have ADR incidence rates for 12/42 of these studies as the child only data was not available (n = 4), data were not split by clinical setting (n = 5), data provided for ADRs in hospital but not causing admission (n = 2) and data were provided for the total number of ADRs but not the ADR frequency at the patient or episode level (n = 1). Figure 1 presents data from all studies that provide incidence rates for ADRs causing admission to hospital (n = 30). These rates range from 0.4% to 10.3% of children (single admission). One study was an extreme outlier [20] and if this was excluded we found a reduction in the upper limit of this range to 4%, and a pooled incidence estimate of 2.9% (2.6%, 3.1%).


Adverse drug reactions in children--a systematic review.

Smyth RM, Gargon E, Kirkham J, Cresswell L, Golder S, Smyth R, Williamson P - PLoS ONE (2012)

What proportion of all paediatric hospital admissions are ADR related?
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3293884&req=5

pone-0024061-g001: What proportion of all paediatric hospital admissions are ADR related?
Mentions: We do not have ADR incidence rates for 12/42 of these studies as the child only data was not available (n = 4), data were not split by clinical setting (n = 5), data provided for ADRs in hospital but not causing admission (n = 2) and data were provided for the total number of ADRs but not the ADR frequency at the patient or episode level (n = 1). Figure 1 presents data from all studies that provide incidence rates for ADRs causing admission to hospital (n = 30). These rates range from 0.4% to 10.3% of children (single admission). One study was an extreme outlier [20] and if this was excluded we found a reduction in the upper limit of this range to 4%, and a pooled incidence estimate of 2.9% (2.6%, 3.1%).

Bottom Line: Anti-infectives and anti-epileptics were the most frequently reported therapeutic class associated with ADRs in children admitted to hospital (17 studies; 12 studies respectively) and children in hospital (24 studies; 14 studies respectively), while anti-infectives and non-steroidal anti-inflammatory drugs (NSAIDs) were frequently reported as associated with ADRs in outpatient children (13 studies; 6 studies respectively).Fourteen studies reported rates ranging from 7%-98% of ADRs being either definitely/possibly avoidable.Although these studies provide estimates of incidence in different settings and some indication of the therapeutic classes most frequently associated with ADRs, further work is needed to address how such ADRs may be prevented.

View Article: PubMed Central - PubMed

Affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, England, United Kingdom. rebecca.smyth@manchester.ac.uk

ABSTRACT

Background: Adverse drug reactions in children are an important public health problem. We have undertaken a systematic review of observational studies in children in three settings: causing admission to hospital, occurring during hospital stay and occurring in the community. We were particularly interested in understanding how ADRs might be better detected, assessed and avoided.

Methods and findings: We searched nineteen electronic databases using a comprehensive search strategy. In total, 102 studies were included. The primary outcome was any clinical event described as an adverse drug reaction to one or more drugs. Additional information relating to the ADR was collected: associated drug classification; clinical presentation; associated risk factors; methods used for assessing causality, severity, and avoidability. Seventy one percent (72/102) of studies assessed causality, and thirty four percent (34/102) performed a severity assessment. Only nineteen studies (19%) assessed avoidability. Incidence rates for ADRs causing hospital admission ranged from 0.4% to 10.3% of all children (pooled estimate of 2.9% (2.6%, 3.1%)) and from 0.6% to 16.8% of all children exposed to a drug during hospital stay. Anti-infectives and anti-epileptics were the most frequently reported therapeutic class associated with ADRs in children admitted to hospital (17 studies; 12 studies respectively) and children in hospital (24 studies; 14 studies respectively), while anti-infectives and non-steroidal anti-inflammatory drugs (NSAIDs) were frequently reported as associated with ADRs in outpatient children (13 studies; 6 studies respectively). Fourteen studies reported rates ranging from 7%-98% of ADRs being either definitely/possibly avoidable.

Conclusions: There is extensive literature which investigates ADRs in children. Although these studies provide estimates of incidence in different settings and some indication of the therapeutic classes most frequently associated with ADRs, further work is needed to address how such ADRs may be prevented.

Show MeSH
Related in: MedlinePlus