背景:尽管以前的努力,儿科的用药安全仍然是一个主要问题。告知改进策略和进一步的研究,特别是在门诊护理,我们系统回顾了有关儿童药物相关住院的频率和性质的文献.
方法:搜索覆盖Embase,Medline,WebofScience,灰色文献来源和相关文章引用。报告在2000年1月1日至2024年1月1日期间发表的儿科药物相关入院流行病学数据的研究符合资格。研究鉴定,数据提取,并根据“JoannaBriggsInstitute”的建议,使用模板进行一式两份的独立评估。
结果:该综述包括45项研究的数据,这些研究报告>24,000例药物不良事件(ADE)或药物不良反应(ADR)住院治疗。由于参考群体不同,共提供52个相对频率值.我们根据研究特征对这些结果进行了分层。作为住院患者的百分比,与药物相关的住院频率最高的是“强化ADE监测”,范围从3.1%到5.8%(5个值),而使用“常规ADE监控”,范围为0.2%至1.0%(3个值)。“与ADR相关的住院治疗”的相对频率为“强化监测”的0.2%至6.9%(23个值),“常规监测”的相对频率为0.04%至3.8%(8个值)。每次急诊就诊,在“强化ADE监测”的研究中,有五个相对频率值在0.1%至3.8%之间,而其他8个值均≤0.1%。异质性阻止了汇总估计。研究很少报道问题的性质,或具有更广泛目标的研究缺乏分类数据。有限的数据表明,三分之一(中位数)与药物相关的入院是可以预防的,尤其是通过更细心的处方。除了多药和肿瘤治疗,没有其他风险因素可以明确识别.信息不足和偏见的高风险,特别是在回顾性和常规观察研究中,妨碍了评估。
结论:鉴于药物相关的住院频率高,儿科用药安全有待进一步提高。由于常规识别似乎不可靠,需要提高临床意识。为了获得更深刻的见解,特别是对于生成改进策略,我们必须在未来的研究中解决报告不足和方法问题。
背景:PROSPERO(CRD42021296986)。
BACKGROUND: Despite previous efforts, medication safety in paediatrics remains a major concern. To inform improvement strategies and further research especially in outpatient care, we systematically reviewed the literature on the frequency and nature of drug-related hospital admissions in children.
METHODS: Searches covered Embase, Medline, Web of Science, grey literature sources and relevant article citations. Studies reporting epidemiological data on paediatric drug-related hospital admissions published between 01/2000 and 01/2024 were eligible. Study identification, data extraction, and critical appraisal were conducted independently in duplicate using templates based on the \'Joanna Briggs Institute\' recommendations.
RESULTS: The review included data from 45 studies reporting > 24,000 hospitalisations for adverse drug events (ADEs) or adverse drug reactions (ADRs). Due to different reference groups, a total of 52 relative frequency values were provided. We stratified these results by study characteristics. As a percentage of inpatients, the highest frequency of drug-related hospitalisation was found with \'intensive ADE monitoring\', ranging from 3.1% to 5.8% (5 values), whereas with \'routine ADE monitoring\', it ranged from 0.2% to 1.0% (3 values). The relative frequencies of \'ADR-related hospitalisations\' ranged from 0.2% to 6.9% for \'intensive monitoring\' (23 values) and from 0.04% to 3.8% for \'routine monitoring\' (8 values). Per emergency department visits, five relative frequency values ranged from 0.1% to 3.8% in studies with \'intensive ADE monitoring\', while all other eight values were ≤ 0.1%. Heterogeneity prevented pooled estimates. Studies rarely reported on the nature of the problems, or studies with broader objectives lacked disaggregated data. Limited data indicated that one in three (median) drug-related admissions could have been prevented, especially by more attentive prescribing. Besides polypharmacy and oncological therapy, no other risk factors could be clearly identified. Insufficient information and a high risk of bias, especially in retrospective and routine observational studies, hampered the assessment.
CONCLUSIONS: Given the high frequency of drug-related hospitalisations, medication safety in paediatrics needs to be further improved. As routine identification appears unreliable, clinical awareness needs to be raised. To gain more profound insights especially for generating improvement strategies, we have to address under-reporting and methodological issues in future research.
BACKGROUND: PROSPERO (CRD42021296986).