Prevalence of Polypharmacy Exposure Among Hospitalized Children in the United States
Prevalence of Polypharmacy Exposure Among Hospitalized Children in the United States
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DOI：
10.1001/archpediatrics.2011.161
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发表时间：
2012-01-01
影响因子：
--
通讯作者：
Metjian, Talene A.
中科院分区：
文献类型：
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作者：
Feudtner, Chris;Dai, Dingwei;Metjian, Talene A.
目的：了解儿科住院患者药物和治疗剂暴露的流行情况和模式。设计：回顾性队列研究。环境：全美共有411家综合医院和52家儿童医院。患者：2006年共有587 427名18岁以下的患者（不包括健康新生儿）住院，占美国所有儿科入院人数的五分之一。主要结局指标：每日和累积药物和治疗剂暴露量。结果：最常见的暴露因患者年龄和医院类型而异，对乙酰氨基酚、沙丁胺醇、各种抗生素、芬太尼、肝素、布洛芬、吗啡、昂丹西琼、异丙酚和雷尼替丁是最常见的暴露。相当一部分患者暴露于多种药物：在儿童医院，在住院的第一天，1岁以下的患者在每日暴露于不同药物的第90百分位数上接受11种药物，1岁或1岁以上的患者接受13种药物；在综合医院，分别为8种和12种药物。到住院第7天，在儿童医院，1岁以下的患者在不同药物累积暴露的第90百分位数上接受了29种药物，1岁或以上的患者接受了35种药物；在综合医院，分别有22种和28种药物。病情不常见的患者更有可能接触到更多的药物(P=。001)。结论：很大一部分住院儿童患者暴露于大量的多种药物，特别是罕见疾病的患者。
Objective: To assess the prevalence and patterns of exposure to drugs and therapeutic agents among hospitalized pediatric patients.Design: Retrospective cohort study.Setting: A total of 411 general hospitals and 52 children's hospitals throughout the United States.Patients: A total of 587 427 patients younger than 18 years, excluding healthy newborns, hospitalized in 2006, representing one-fifth of all pediatric admissions in the United States.Main Outcome Measures: Daily and cumulative exposure to drugs and therapeutic agents.Results: The most common exposures varied by patient age and by hospital type, with acetaminophen, albuterol, various antibiotics, fentanyl, heparin, ibuprofen, morphine, ondansetron, propofol, and ranitidine being among the most prevalent exposures. A consider-able fraction of patients were exposed to numerous medications: in children's hospitals, on the first day of hospitalization, patients younger than 1 year at the 90th percentile of daily exposure to distinct medications received 11 drugs, and patients 1 year or older received 13 drugs; in general hospitals, 8 and 12 drugs, respectively. By hospital day 7, in children's hospitals, patients younger than 1 year at the 90th percentile of cumulative exposure to distinct distinct medications had received 29 drugs, and patients 1 year or older had received 35; in general hospitals, 22 and 28 drugs, respectively. Patients with less common conditions were more likely to be exposed to more drugs (P= . 001).Conclusion: A large fraction of hospitalized pediatric patients are exposed to substantial polypharmacy, especially patients with rare conditions.