Adult and Child Center for Health Outcomes Research & Delivery Science (ACCORDS) (J.A.F.,A.K.), University of Colorado and Children's Hospital Colorado, Aurora, Colorado, USA; Division of General Pediatrics, Department of Pediatrics (C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Skaggs School of Pharmacy & Pharmaceutical Sciences (L.E.O.), University of Colorado, Aurora, Colorado, USA.
Adult and Child Center for Health Outcomes Research & Delivery Science (ACCORDS) (J.A.F.,A.K.), University of Colorado and Children's Hospital Colorado, Aurora, Colorado, USA; Division of General Pediatrics, Department of Pediatrics (C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Skaggs School of Pharmacy & Pharmaceutical Sciences (L.E.O.), University of Colorado, Aurora, Colorado, USA.
J Pain Symptom Manage. 2023 Feb;65(2):e109-e114. doi: 10.1016/j.jpainsymman.2022.10.013. Epub 2022 Nov 2.
Children with severe neurological impairment and polypharmacy are exposed to anticholinergic (AC) medications that may have anticholinergic side effects, but this is understudied. Anticholinergic Cognitive Burden (ACB) scores measure total anticholinergic burden for a medication regimen, and scores ≥3 have been associated with increased morbidity and mortality in adults.
We assessed the relationship between ACB scores and parent-reported anticholinergic symptoms in children.
Cross-sectional study of patients one to 18 years-old with ICD-defined severe neurological impairment and polypharmacy. At routine clinical visits, total ACB scores were computed for all medications. Parent-reported AC symptoms (constipation, drowsiness, difficulty concentrating, dry mouth, or urinary problems) were assessed. Multivariable logistic regression was used to test the association between total ACB scores ≥3 for scheduled medications and the presence of AC symptoms, adjusted for age and recent acute healthcare utilization.
Among 123 unique patients, 87% were prescribed AC medications. Common AC medication classes included: systemic antihistamines (64%), anxiolytics (53%), antidepressants (30%), H2 blockers (22%), and muscle relaxants (20%). Total ACB scores ≥3 were observed in 44% for scheduled medications and in 63% of patients for scheduled plus PRN medications. Total ACB scores ≥3 were significantly associated with an increased odds of ≥1 anticholinergic symptoms for scheduled medications (OR: 3.1; 95% CI: 1.4, 6.7) and for scheduled plus PRN medications (OR: 2.9; 95% CI: 1.3, 6.4).
If replicated in larger populations, the association between elevated total ACB scores and anticholinergic side effects in children should prompt clinicians to consider deprescribing potentially unneeded anticholinergic medications.
患有严重神经功能障碍和多种药物治疗的儿童会接触到可能具有抗胆碱能副作用的抗胆碱能药物，但对此研究甚少。抗胆碱能认知负担 (ACB) 评分用于衡量药物治疗方案的总抗胆碱能负担，评分≥3 与成人发病率和死亡率增加有关。
我们评估了 ACB 评分与父母报告的儿童抗胆碱能症状之间的关系。
对患有 ICD 定义的严重神经功能障碍和多种药物治疗的 1 至 18 岁患者进行横断面研究。在常规临床就诊时，计算所有药物的总 ACB 评分。评估父母报告的抗胆碱能症状（便秘、嗜睡、注意力不集中、口干或排尿问题）。多变量逻辑回归用于测试计划药物的总 ACB 评分≥3 与抗胆碱能症状的存在之间的关联，调整年龄和近期急性医疗保健利用情况。
在 123 名独特患者中，87%的患者开了 AC 药物。常见的 AC 药物类别包括：全身抗组胺药（64%）、抗焦虑药（53%）、抗抑郁药（30%）、H2 阻滞剂（22%）和肌肉松弛剂（20%）。计划药物的总 ACB 评分≥3 占 44%，计划加 PRN 药物的总 ACB 评分≥3 占 63%。总 ACB 评分≥3 与计划药物（比值比：3.1；95%置信区间：1.4，6.7）和计划加 PRN 药物（比值比：2.9；95%置信区间：1.3，6.4）发生≥1 种抗胆碱能症状的几率增加显著相关。
如果在更大的人群中得到复制，儿童中升高的总 ACB 评分与抗胆碱能副作用之间的关联应促使临床医生考虑减少潜在不必要的抗胆碱能药物。
