Background and importance Drug-related admissions (DRAs) are an important cause of preventable harm in older adults, in particular in those aged 85 years and older. Characterisation and prevention of incident DRAs in older adults requires a standardised approach for DRA causality adjudication. Multiple algorithms exist to assess causality of adverse drug reactions, including the Naranjo algorithm and an adjusted version of the Kramer algorithm. The performance of these tools in assessing DRA causality has however not been robustly demonstrated.
Aim and objectives This study aimed to evaluate the ability of the adjusted Kramer algorithm to adjudicate DRA causality in geriatric inpatients. The secondary objectives were to characterise DRAs in this patient population and to identify independent determinants for a DRA.
Material and methods DRAs were assessed in a convenience sample of patients admitted to the acute geriatric wards of an academic hospital. DRAs were identified by expert consensus and causality was evaluated using the Naranjo and the adjusted Kramer algorithms. Positive agreement with expert consensus was calculated for both algorithms. A multivariable logistic regression analysis was performed to explore determinants for a DRA.
Results A total of 218 geriatric inpatients were included of which 65 (29.8%) experienced a DRA. Positive agreement was 72.3% (95% CI 59.6% to 82.3%) and 100% (95% CI 93.0% to 100%) for the Naranjo and the adjusted Kramer algorithm, respectively. Diuretics were the main culprits and most DRAs were attributed to a fall (n=18; 27.7%). A fall-related principal diagnosis was independently associated with a DRA (OR 20.11; 95% CI 5.60 to 72.24).
Conclusion and relevance The adjusted Kramer algorithm demonstrated a higher positive agreement with expert consensus in assessing DRA causality in geriatric inpatients compared to the Naranjo algorithm. Our results support implementation of the adjusted Kramer algorithm as part of a standardised DRA assessment approach in older adults. Cardiovascular agents and central nervous system drugs were the main perpetrators for DRAs, underlining the need for preventive initiatives targeting these drug classes. In our geriatric inpatient population, a fall-related principal admission diagnosis was identified as an independent determinant for a DRA. Additional research, focusing on identification of older adults at risk for a DRA and implementation of preventive strategies, is needed.
Conflict of interest No conflict of interest
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