1 in 6 Paediatric ICU Patients in England Harmed by Medications

Pavankumar Kamat

December 08, 2021

Adverse drug events (ADEs) are common in paediatric intensive care units (PICUs) in England, with 1 in 6 patients experiencing one or more ADEs during their stay in the PICU. Furthermore, the majority of ADEs occurring in PICUs are preventable. The findings were reported in a study published today in the British Journal of Clinical Pharmacology.

"This work supports the national and international efforts to reduce preventable medication harm," the authors of the study said.

Researchers conducted a prospective cohort study across PICUs of three NHS children's hospitals in England involving 302 patients aged 18 years and younger who remained in the PICU for a minimum of 24 hours. ADEs, defined as 'injuries resulting from the use of a drug' were identified by trained pharmacists, whereas the assessment of causality, preventability, and severity of the ADEs was performed by a multidisciplinary team of experts.

A total of 62 confirmed ADEs (definite/probable causality) were reported among the 302 patients, which translates to an estimated incidence of 20.5 (95% CI 15.3 to 27.5) per 100 patients and 16.7 (95% CI 9.3 to 29.9) per 1000 patient-days. 15.6% of patients experienced at least one confirmed ADE during their say in the PICU. 58.1% of ADEs were deemed preventable by the experts.

Around a third of the ADEs (32.3%) were considered temporary harm, permanent harm, and near-death events, likely to have resulted in prolonged hospitalisation. A crucial risk factor for ADEs was prolonged length of stay in the PICU (≥7 days vs 1-6 days: OR 6.29; 95% CI 2.42 to 16.32).

The drugs most commonly involved with ADEs were medications for central nervous system (22.6%), infections (20.9%), and cardiovascular system (19.4%). High-risk medications such as anticoagulants, adrenergic antagonists, and aminoglycosides were implicated in the occurrence of the most serious ADEs.

Lead author, Dr Anwar A. Alghamdi, from the University of Manchester, said: "This multicentre study is the first of its kind in the UK hospitals, and its findings can guide future remedial interventions to reduce avoidable medication-related harm in this vulnerable patient population."

Some of the remedial interventions include reducing the length of patient stay in PICU, ensuring safe and judicious use of high-risk medications, and assessing prescribing practices and processes.

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