Dai Dingwei, Feinstein James A, Morrison Wynne, Zuppa Athena F, Feudtner Chris
1Pediatric Advanced Care Team and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Philadelphia, PA. 2Adult and Child Consortium for Health Outcomes Research and Delivery Science, Children's Hospital Colorado, Aurora, CO. 3Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO. 4Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia; Philadelphia, PA. 5Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 6Center for Clinical Pharmacology, The Children's Hospital of Philadelphia; Philadelphia, PA.
Pediatr Crit Care Med. 2016 May;17(5):e218-28. doi: 10.1097/PCC.0000000000000684.
Polypharmacy is common in hospitalized children in the United States and has been identified as a major risk factor for exposure to potential drug-drug interactions. Little is known about the characteristics and prevalence of exposure of pediatric patients to polypharmacy and potential drug-drug interactions in PICUs.
Retrospective cohort study using the Pediatric Health Information System database.
Forty-two freestanding children's hospitals throughout the United States.
A total of 54,549 patients less than 18 years old cared for in PICUs in 2011. Patients in neonatal ICUs were not included.
PICU patients were on average exposed to 10 distinct drugs each hospital day and to 20 drugs cumulatively during their hospitalization. Seventy-five percent of patients were exposed to greater than or equal to one potential drug-drug interaction regardless of severity level, 6% to greater than or equal to one contraindicated potential drug-drug interaction, 69% to greater than or equal to one major potential drug-drug interaction, 57% to greater than or equal to one moderate potential drug-drug interaction, 19% to greater than or equal to one minor potential drug-drug interaction. Potential drug-drug interaction exposures were significantly associated with specific diagnoses (p < 0.001), presence of complex chronic conditions (p < 0.001), increasing number of total distinct drugs used (p < 0.001), increasing length of stay in PICU (p < 0.001), and white race (p < 0.001).
Many PICU patients are exposed to substantial polypharmacy and potential drug-drug interactions. Future research should identify the risk of adverse drug events following specific potential drug-drug interaction exposures, especially the risk of adverse drug events due to multiple potential drug-drug interaction exposures, and determine the probability and magnitude of the actual harm (if any) for each specific potential drug-drug interaction, especially for multiple potential drug-drug interaction exposures.
在美国，住院儿童中联合用药很常见，并且已被确定为发生潜在药物相互作用的主要危险因素。关于儿科重症监护病房（PICU）中患儿联合用药及潜在药物相互作用的特征和发生率，人们了解甚少。
使用儿科健康信息系统数据库进行回顾性队列研究。
美国42家独立儿童医院。
2011年在PICU接受治疗的18岁以下患者共54549例。新生儿重症监护病房的患者未纳入。
PICU患者平均每天在每家医院接触10种不同药物，住院期间累计接触20种药物。75%的患者接触过至少一种潜在药物相互作用，无论严重程度如何；6%的患者接触过至少一种禁忌潜在药物相互作用；69%的患者接触过至少一种主要潜在药物相互作用；57%的患者接触过至少一种中度潜在药物相互作用；19%的患者接触过至少一种轻度潜在药物相互作用。潜在药物相互作用暴露与特定诊断（p<0.001）、复杂慢性病的存在（p<0.001）、使用的不同药物总数增加（p<0.001）、在PICU的住院时间延长（p<0.001）以及白人种族（p<0.001）显著相关。
许多PICU患者存在大量联合用药及潜在药物相互作用。未来的研究应确定特定潜在药物相互作用暴露后发生药物不良事件的风险，尤其是多种潜在药物相互作用暴露导致药物不良事件的风险，并确定每种特定潜在药物相互作用（尤其是多种潜在药物相互作用暴露）实际造成伤害（如有）的可能性和程度。
