Performance of Triggers in Detecting Hospitalizations Related to Drug-induced Respiratory Disorders in Older Adults: A Pilot Cross-sectional Study

Overview

Journal Clinics (Sao Paulo)

Publisher Elsevier

Specialty General Medicine

Date 2024 Jul 28

PMID 39068723

Authors

Geovana Schiavo

Marcela Forgerini

Fabiana Rossi Varallo

Bruna Carolina Correa

Maisa Cabete Pereira Salvetti

Patricia de Carvalho Mastroianni

Affiliations

Soon will be listed here.

Abstract

Background: There is no gold-standard trigger for detecting drug-induced respiratory disorders, a type of Adverse Drug Event (ADE) with high morbimortality, particularly in older people.

Objective: To propose and evaluate the performance of triggers for detecting hospitalizations related to drug-induced respiratory disorders in older people.

Methods: A pilot cross-sectional study was conducted with older people (age ≥ 60) admitted to a Brazilian hospital. Electronic chart documentation was screened using ICD-10 codes; Global Trigger Tool (GTT); and drugs potentially associated with respiratory disorders. A chart and medication review were conducted to perform the causality assessment using the instrument developed by the World Health Organization. The performance of triggers was evaluated by the Positive Predictive Value (PPV), with values ≥ 0.20 indicating good performance.

Results: Among 221 older people, 72 were eligible. Potential drug-induced dyspnea and/or cough were detected in six older people (6/72), corresponding to a prevalence of 8.3 %. The overall PPV of the triggers was 0.14, with abrupt medication stop (PPV = 1.00), codeine (PPV = 1.00), captopril (PPV = 0.33), and carvedilol (PPV = 0.33) showing good performance. Two triggers were proposed for detecting therapeutic ineffectiveness associated with respiratory disorders: furosemide (PPV = 0.23) and prednisone (PPV = 0.20).

Conclusion: The triggers enabled the identification that one in 12 hospitalizations was related to drug-induced respiratory. Although good performance was observed in the application of triggers, additional investigations are needed to assess the feasibility of incorporating them into clinical practice for the screening, detection, management, and reporting of these ADEs, which are considered to be underreported and difficult to detect.

References

Toscano Guzman M, Galvan Banqueri M, Otero M, Sanchez Fidalgo S, Font Noguera I, Guerrero M . Validating a Trigger Tool for Detecting Adverse Drug Events in Elderly Patients With Multimorbidity (TRIGGER-CHRON). J Patient Saf. 2018; 17(8):e976-e982. DOI: 10.1097/PTS.0000000000000552. View

Manias E, Kabir M, Maier A . Inappropriate medications and physical function: a systematic review. Ther Adv Drug Saf. 2021; 12:20420986211030371. PMC: 8287273. DOI: 10.1177/20420986211030371. View

Taylor A, Verma N, Slater R, Mohammed T . Bad for Breathing: A Pictorial of Drug-Induced Pulmonary Disease. Curr Probl Diagn Radiol. 2016; 45(6):429-432. DOI: 10.1067/j.cpradiol.2015.10.002. View

Forgerini M, Schiavo G, Lucchetta R, Mastroianni P . Drug interactions for elderly people with mental and behavioral disorders: a systematic scoping review. Arch Gerontol Geriatr. 2020; 93:104283. DOI: 10.1016/j.archger.2020.104283. View

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008; 61(4):344-9. DOI: 10.1016/j.jclinepi.2007.11.008. View

Storesund A, Haugen A, Hjortas M, Nortvedt M, Flaatten H, Eide G . Accuracy of surgical complication rate estimation using ICD-10 codes. Br J Surg. 2018; 106(3):236-244. PMC: 6519147. DOI: 10.1002/bjs.10985. View

Silva C, Muller N . Drug-induced lung diseases: most common reaction patterns and corresponding high-resolution CT manifestations. Semin Ultrasound CT MR. 2006; 27(2):111-6. DOI: 10.1053/j.sult.2006.01.001. View

Carnevali L, Krug B, Amant F, Van Pee D, Gerard V, de Bethune X . Performance of the adverse drug event trigger tool and the global trigger tool for identifying adverse drug events: experience in a Belgian hospital. Ann Pharmacother. 2013; 47(11):1414-9. DOI: 10.1177/1060028013500939. View

Negishi A, Oshima S, Horii N, Mutoh M, Inoue N, Numajiri S . Categorisation of Pharmaceutical Adverse Events Using the Japanese Adverse Drug Event Report Database: Characteristic Adverse Drug Events of the Elderly Treated with Polypharmacy. Drugs Real World Outcomes. 2020; 8(1):49-61. PMC: 7984209. DOI: 10.1007/s40801-020-00221-8. View

10.

Varallo F, Planeta C, Herdeiro M, Mastroianni P . Imputation of adverse drug reactions: Causality assessment in hospitals. PLoS One. 2017; 12(2):e0171470. PMC: 5293251. DOI: 10.1371/journal.pone.0171470. View

11.

Varallo F, Dagli-Hernandez C, Pagotto C, de Nadai T, Herdeiro M, Mastroianni P . Confounding Variables and the Performance of Triggers in Detecting Unreported Adverse Drug Reactions. Clin Ther. 2016; 39(4):686-696. DOI: 10.1016/j.clinthera.2016.11.005. View

12.

Zerah L, Henrard S, Thevelin S, Feller M, Meyer-Massetti C, Knol W . Performance of a trigger tool for detecting drug-related hospital admissions in older people: analysis from the OPERAM trial. Age Ageing. 2021; 51(1). DOI: 10.1093/ageing/afab196. View

13.

Rozenfeld S, Giordani F, Coelho S . [Adverse drug events in hospital: pilot study with trigger tool]. Rev Saude Publica. 2014; 47(6):1102-11. PMC: 4206103. DOI: 10.1590/s0034-8910.2013047004735. View

14.

Ben-Noun L . Drug-induced respiratory disorders: incidence, prevention and management. Drug Saf. 2000; 23(2):143-64. DOI: 10.2165/00002018-200023020-00005. View

15.

Schiavo G, Forgerini M, Varallo F, Falavigna L, Lucchetta R, Mastroianni P . Application of trigger tools for detecting adverse drug events in older people: A systematic review and meta-analysis. Res Social Adm Pharm. 2024; 20(7):576-589. DOI: 10.1016/j.sapharm.2024.03.008. View

16.

Woo S, Yoon J, Doo G, Park Y, Lee Y, Lee S . Common causes and characteristics of adverse drug reactions in older adults: a retrospective study. BMC Pharmacol Toxicol. 2020; 21(1):87. PMC: 7727226. DOI: 10.1186/s40360-020-00464-9. View

17.

Otero M, Schmitt E . Clarifying terminology for adverse drug events. Ann Intern Med. 2005; 142(1):77. DOI: 10.7326/0003-4819-142-1-200501040-00016. View

18.

Sohrabi C, Mathew G, Franchi T, Kerwan A, Griffin M, Soleil C Del Mundo J . Impact of the coronavirus (COVID-19) pandemic on scientific research and implications for clinical academic training - A review. Int J Surg. 2021; 86:57-63. PMC: 7833269. DOI: 10.1016/j.ijsu.2020.12.008. View

19.

Robb G, Loe E, Maharaj A, Hamblin R, Seddon M . Medication-related patient harm in New Zealand hospitals. N Z Med J. 2017; 130(1460):21-32. View

20.

Raso J, Santos L, Reis D, Frangiotti M, Zanetti A, Capucho H . Hospitalizations of older people in an emergency department related to potential medication-induced hyperactive delirium: a cross-sectional study. Int J Clin Pharm. 2022; 44(2):548-556. DOI: 10.1007/s11096-022-01378-8. View