Julia A Heneghan1, Eduardo A Trujillo Rivera2, Qing Zeng-Treitler2, Farhana Faruqe3, Hiroki Morizono4, James E Bost3, Murray M Pollack1, Anita K Patel1. 1. Division of Critical Care Medicine, Department of Pediatrics, Children's National Health System and George Washington University School of Medicine and Health Sciences, Washington, DC. 2. Biomedical Informatics Center, George Washington University School of Medicine and Health Sciences, Washington, DC. 3. Children's National Health System, Washington, DC. 4. Department of Genomics and Precision Medicine, Center for Genetic Medicine, Children's National Health System and George Washington University School of Medicine and Health Sciences, Washington, DC.
Abstract
OBJECTIVE: To examine medication administration records through electronic health record data to provide a broad description of the pharmaceutical exposure of critically ill children. DESIGN: Retrospective cohort study using the Cerner Health Facts database. SETTING: United States. PATIENTS: A total of 43,374 children 7 days old to less than 22 years old receiving intensive care with available pharmacy data. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 907,440 courses of 1,080 unique medications were prescribed with a median of nine medications (range, 1-99; 25-75th percentile, 5-16) per patient. The most common medications were acetaminophen, ondansetron, and morphine. Only 45 medications (4.2%) were prescribed to more than 5% of patients, and these accounted for 442,067 (48.7%) of the total courses of medications. Each additional medication was associated with increased univariate risk of mortality (odds ratio, 1.05; 95% CI, 1.05-1.06; p < 0.001). CONCLUSIONS: Children receiving intensive care receive a median of nine medications per patient and one quarter are prescribed at least than 16 medications. Only 45 medications were prescribed to more than 5% of patients, but these accounted for almost half of all medication courses.
OBJECTIVE: To examine medication administration records through electronic health record data to provide a broad description of the pharmaceutical exposure of critically ill children. DESIGN: Retrospective cohort study using the Cerner Health Facts database. SETTING: United States. PATIENTS: A total of 43,374 children 7 days old to less than 22 years old receiving intensive care with available pharmacy data. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 907,440 courses of 1,080 unique medications were prescribed with a median of nine medications (range, 1-99; 25-75th percentile, 5-16) per patient. The most common medications were acetaminophen, ondansetron, and morphine. Only 45 medications (4.2%) were prescribed to more than 5% of patients, and these accounted for 442,067 (48.7%) of the total courses of medications. Each additional medication was associated with increased univariate risk of mortality (odds ratio, 1.05; 95% CI, 1.05-1.06; p < 0.001). CONCLUSIONS: Children receiving intensive care receive a median of nine medications per patient and one quarter are prescribed at least than 16 medications. Only 45 medications were prescribed to more than 5% of patients, but these accounted for almost half of all medication courses.
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