Article Figures & Data
Figures
- FIGURE 1
Types of acute medications associated with a potential drug-drug interaction. Note: there is overlap where some patients have interactions with multiple acute medication types.
- FIGURE 2
Year of CPOE implementation at study hospitals. Note: 4 hospitals had not initiated CPOE at the time of this study and are not included in the figure.
Tables
- TABLE 1
Characteristics of Hospitalized Patients Treated With an AED and Those With a pDDI
pDDIs Treated With an AED (N = 434 794) Severe (n = 117 880) Nonsevere (n = 63 500) None (n = 253 414) Age, median (IQR), y 8.3 (2.7, 14.3) 6.5 (0.8, 14.1) 11.0 (5.0, 15.5) 8.2 (3.2, 18.3) Male gender, % 53.4 52.2 56.5 53.4 Number of hospital days, median (IQR) 3 (2, 8) 6 (3, 16) 4 (2, 9) 3 (1, 9) Number of AEDs per hospitalization, median (IQR) 1 (1, 2) 1 (1, 2) 1 (1, 2) 1 (1, 2) Number of non-AEDs per hospitalization, median (IQR) 12 (6, 21) 20 (12, 31) 14 (8, 22) 8 (4,16) ICU stay, % 27.6 45.5 27.7 19.2 Operating room procedure, % 26.1 44.5 27.0 17.2 Number of consulting services, median (IQR) 2 (0, 2) 2 (0, 2) 2 (0, 2) 2 (0, 2) Diagnosis count, median (IQR) 6 (3, 11) 8 (5, 14) 7 (4, 11) 5 (3, 9) Most common specialty of attending physician (top 3), % Pediatrics (22.2), Neurology (19.4), Hematology-Oncology (8.8) Pediatrics (21.8), Neurology (10.0), Surgery-Neurologic (9.5) Pediatrics (21.4), Neurology (14.1), Hematology-Oncology (12.0) Neurology (25.2), Pediatrics (22.6), Hematology-Oncology (9.7) Most common APR-DRG diagnosis (top 3), % Seizure (25.4), craniotomy for trauma (3.6), chemotherapy (3.1) Seizure (12.3), craniotomy for trauma (5.5), migraine/other headache (4.7) Seizure (19.1), bipolar (4.3), craniotomy for trauma (4.0) Seizure (33.0), chemotherapy (4.2), craniotomy for trauma (2.7) A Kruskal-Wallis or χ2 analysis was performed to compare patients with severe, nonsevere, and no potential drug-drug interactions. All results were significant (P < .001). The most common specialties and diagnoses were not compared statistically. APR-DRG, all patient refined-diagnosis–related group; IQR, interquartile range.
- TABLE 2
AEDs and the Most Common Interacting Drugs as a Percentage of Hospitalizations With an AED
Hospitalizations With pDDIs (N = 181 380) Hospitalizations With Severe pDDIs (N = 117 880) AED All Hospitalizations Associated With an AED (N = 434 794), N n %a Drugs (Top 3) %a n %b Drugs (Top 3) %b Phenobarbital 96 997 72 101 39.8 Lorazepam 17.2 61 932 52.5 Lorazepam 26.5 Midazolam 15.3 Midazolam 23.6 Morphine 14.8 Morphine 22.7 Valproic acid 70 764 31 918 17.6 Lorazepam 8.2 10 713 9.1 Ketorolac 6.9 Ketorolac 4.5 Trazodone 1.3 Risperidone 3.1 Meropenem 0.8 Phenytoin 31 712 25 786 14.2 Ranitidine 6.2 11 730 10.0 Lidocaine 6.0 Fentanyl 5.3 Dopamine 2.0 Midazolam 5.1 Lidocaine and prilocaine 1.8 Gabapentin 55 515 23 457 12.9 Morphine 10.9 8660 7.3 Ketorolac 6.8 Ketorolac 4.4 Naproxen 0.9 Naproxen 0.6 — — Clonazepam 50 857 15 636 8.6 Morphine 5.7 15 479 13.1 Morphine 8.8 Oxycodone 1.5 Oxycodone 2.4 Hydromorphone 1.3 Hydromorphone 1.9 Carbamazepine 22 067 13 224 7.3 Fentanyl 2.9 2744 2.3 Ketorolac 1.7 Midazolam 2.4 Trazodone 0.2 Dexamethasone 1.3 Nifedipine 0.2 Topiramate 58 531 9798 5.4 Ketorolac 3.8 8161 6.9 Ketorolac 5.8 Amitriptyline 0.8 Citalopram 0.6 Acetazolamide 0.5 Naproxen 0.5 Levetiracetam 134 859 7519 4.1 Ketorolac 4.1 7519 6.4 Ketorolac 6.4 Oxcarbazepine 54 653 4578 2.5 Ketorolac 1.9 4221 3.6 Ketorolac 2.9 Citalopram 0.3 Citalopram 0.5 Naproxen 0.1 Naproxen 0.2 Lamotrigine 38 300 3655 2.0 Risperidone 1.2 0 — — — Sertraline 0.5 Escitalopram 0.3 Pregabalin 5810 1299 0.7 Ketorolac 0.7 1299 1.1 Ketorolac 1.0 Naproxen 0.1 Naproxen 0.1 Primidone 1353 897 0.5 Lorazepam 0.2 741 0.6 Lorazepam 0.3 Diazepam 0.2 Diazepam 0.3 Midazolam 0.1 Midazolam 0.2 Clobazam 721 217 0.1 Morphine 0.0 133 0.1 Morphine 0.1 Omeprazole 0.0 Oxycodone 0.0 Oxycodone 0.0 Hydromorphone 0.0 Rufinamide 3510 192 0.1 Ketorolac 0.1 192 0.2 Ketorolac 0.2 Naproxen 0.0 Naproxen 0.0 Lacosamide 2910 152 0.1 Ketorolac 0.1 152 0.1 Ketorolac 0.1 Naproxen 0.0 Naproxen 0.0 Zonisamide 21 490 115 0.1 Metformin 0.0 115 0.1 Metformin 0.1 Naproxen 0.0 Naproxen 0.0 Tiagabine 656 73 0.0 Ketorolac 0.0 73 0.1 Ketorolac 0.1 Naproxen 0.0 Naproxen 0.0 Vigabatrin 681 4 0.0 Ketorolac 0.0 4 0.0 Ketorolac 0.0 Felbamate 6653 3 0.0 Warfarin 0.0 0 — — — Ethotoin 78 2 0.0 Ketorolac 0.0 2 0.0 Ketorolac 0.0 Ethosuximide 2487 0 — — — — — — — Methsuximide 219 0 — — — — — — — pDDIs Number of Hospitalizations Any Severe Total 434 794 181 380 (41.7) 117 880 (27.1) CPOE status P = .48 P = .91 Pre-CPOE 208 427 89 023 (42.7) 58 145 (27.9) Post-CPOE 226 367 92 357 (40.8) 59 735 (26.4) Admit year P < .001 P < .001 2005 46 812 23 198 (49.6) 14 748 (31.5) 2006 50 366 24 392 (48.4) 15 716 (31.2) 2007 55 529 25 184 (45.4) 16 437 (29.6) 2008 58 847 24 832 (42.2) 16 365 (27.8) 2009 63 052 24 332 (38.6) 15 830 (25.1) 2010 56 665 21 532 (38.0) 13 884 (24.5) 2011 69 076 25 520 (36.9) 16 707 (24.2) 2012 34 457 12 390 (36.0) 8193 (23.8) Data are presented as n (%) unless otherwise indicated. Post-CPOE begins in the year after the year of CPOE implementation. The effect of CPOE status and year of admission on the likelihood of a pDDI was evaluated with a random intercept logistic regression model, with observations clustered by hospital.
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