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Development and validation of a risk model for predicting adverse drug reactions in older people during hospital stay: Brighton Adverse Drug Reactions Risk (BADRI) model.

Tangiisuran B, Scutt G, Stevenson J, Wright J, Onder G, Petrovic M, van der Cammen TJ, Rajkumar C, Davies G - PLoS ONE (2014)

Bottom Line: Having a validated clinical tool to identify those older patients at risk of developing an ADR during hospital stay would enable healthcare staff to put measures in place to reduce the risk of such an event developing.We have developed and successfully validated a simple model to use ADR risk score in a population of patients with a median age of 85, i.e. the oldest old.The model is based on 5 clinical variables (≥8 drugs, hyperlipidaemia, raised white cell count, use of anti-diabetic agents, length of stay ≥12 days), some of which have not been previously reported.

View Article: PubMed Central - PubMed

Affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains, Malaysia, Pulau Pinang, Malaysia.

ABSTRACT

Background: Older patients are at an increased risk of developing adverse drug reactions (ADR). Of particular concern are the oldest old, which constitute an increasingly growing population. Having a validated clinical tool to identify those older patients at risk of developing an ADR during hospital stay would enable healthcare staff to put measures in place to reduce the risk of such an event developing. The current study aimed to (1) develop and (2) validate an ADR risk prediction model.

Methods: We used a combination of univariate analysis and multivariate binary logistic regression to identify clinical risk factors for developing an ADR in a population of older people from a UK teaching hospital. The final ADR risk model was then validated in a European population (European dataset).

Results: Six-hundred-ninety patients (median age 85 years) were enrolled in the development stage of the study. Ninety-five reports of ADR were confirmed by independent review in these patients. Five clinical variables were identified through multivariate analysis and included in our final model; each variable was attributed a score of 1. Internal validation produced an AUROC of 0.74, a sensitivity of 80%, and specificity of 55%. During the external validation stage the AUROC was 0.73, with sensitivity and specificity values of 84% and 43% respectively.

Conclusions: We have developed and successfully validated a simple model to use ADR risk score in a population of patients with a median age of 85, i.e. the oldest old. The model is based on 5 clinical variables (≥8 drugs, hyperlipidaemia, raised white cell count, use of anti-diabetic agents, length of stay ≥12 days), some of which have not been previously reported.

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ADR rate according to ADR risk score.The BADRI risk model was applied to all 690 patients from the Brighton dataset (A), and 483 patients from the European dataset (B). The ADR rate is calculated as the proportion of patients in each scoring category that suffered an ADR. For both datasets there is a general increase in the ADR rate as the risk score increases.
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pone-0111254-g002: ADR rate according to ADR risk score.The BADRI risk model was applied to all 690 patients from the Brighton dataset (A), and 483 patients from the European dataset (B). The ADR rate is calculated as the proportion of patients in each scoring category that suffered an ADR. For both datasets there is a general increase in the ADR rate as the risk score increases.

Mentions: Following development of the BADRI risk model, we attributed an ADR risk score to each patient in the Brighton dataset based of the number of variables present. For simplicity, an equal weighting of 1 was attributed to each variable. The range of the risk scores for patients in the Brighton dataset was 0–5, with a mean of 1.5, standard deviation of 1.05, and a median of 1. When grouped according to BADRI risk model, there was a clear relationship between risk score, and the proportion of ADRs (Figure 2A).


Development and validation of a risk model for predicting adverse drug reactions in older people during hospital stay: Brighton Adverse Drug Reactions Risk (BADRI) model.

Tangiisuran B, Scutt G, Stevenson J, Wright J, Onder G, Petrovic M, van der Cammen TJ, Rajkumar C, Davies G - PLoS ONE (2014)

ADR rate according to ADR risk score.The BADRI risk model was applied to all 690 patients from the Brighton dataset (A), and 483 patients from the European dataset (B). The ADR rate is calculated as the proportion of patients in each scoring category that suffered an ADR. For both datasets there is a general increase in the ADR rate as the risk score increases.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214735&req=5

pone-0111254-g002: ADR rate according to ADR risk score.The BADRI risk model was applied to all 690 patients from the Brighton dataset (A), and 483 patients from the European dataset (B). The ADR rate is calculated as the proportion of patients in each scoring category that suffered an ADR. For both datasets there is a general increase in the ADR rate as the risk score increases.
Mentions: Following development of the BADRI risk model, we attributed an ADR risk score to each patient in the Brighton dataset based of the number of variables present. For simplicity, an equal weighting of 1 was attributed to each variable. The range of the risk scores for patients in the Brighton dataset was 0–5, with a mean of 1.5, standard deviation of 1.05, and a median of 1. When grouped according to BADRI risk model, there was a clear relationship between risk score, and the proportion of ADRs (Figure 2A).

Bottom Line: Having a validated clinical tool to identify those older patients at risk of developing an ADR during hospital stay would enable healthcare staff to put measures in place to reduce the risk of such an event developing.We have developed and successfully validated a simple model to use ADR risk score in a population of patients with a median age of 85, i.e. the oldest old.The model is based on 5 clinical variables (≥8 drugs, hyperlipidaemia, raised white cell count, use of anti-diabetic agents, length of stay ≥12 days), some of which have not been previously reported.

View Article: PubMed Central - PubMed

Affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains, Malaysia, Pulau Pinang, Malaysia.

ABSTRACT

Background: Older patients are at an increased risk of developing adverse drug reactions (ADR). Of particular concern are the oldest old, which constitute an increasingly growing population. Having a validated clinical tool to identify those older patients at risk of developing an ADR during hospital stay would enable healthcare staff to put measures in place to reduce the risk of such an event developing. The current study aimed to (1) develop and (2) validate an ADR risk prediction model.

Methods: We used a combination of univariate analysis and multivariate binary logistic regression to identify clinical risk factors for developing an ADR in a population of older people from a UK teaching hospital. The final ADR risk model was then validated in a European population (European dataset).

Results: Six-hundred-ninety patients (median age 85 years) were enrolled in the development stage of the study. Ninety-five reports of ADR were confirmed by independent review in these patients. Five clinical variables were identified through multivariate analysis and included in our final model; each variable was attributed a score of 1. Internal validation produced an AUROC of 0.74, a sensitivity of 80%, and specificity of 55%. During the external validation stage the AUROC was 0.73, with sensitivity and specificity values of 84% and 43% respectively.

Conclusions: We have developed and successfully validated a simple model to use ADR risk score in a population of patients with a median age of 85, i.e. the oldest old. The model is based on 5 clinical variables (≥8 drugs, hyperlipidaemia, raised white cell count, use of anti-diabetic agents, length of stay ≥12 days), some of which have not been previously reported.

Show MeSH
Related in: MedlinePlus