Nazanin Falconer1,2,3, Michael Barras4,5, Ahmad Abdel-Hafiz5, Sam Radburn5, Neil Cottrell4,6. 1. School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, BrisbaneWoolloongabba, Brisbane, QLD, 4102, Australia. n.ghahremanfalconer@uq.edu.au. 2. Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, 4102, Australia. n.ghahremanfalconer@uq.edu.au. 3. Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, 4102, Australia. n.ghahremanfalconer@uq.edu.au. 4. School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, BrisbaneWoolloongabba, Brisbane, QLD, 4102, Australia. 5. Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, 4102, Australia. 6. Faculty of Health and Interprofessional Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia.
Abstract
PURPOSE: To externally evaluate the performance of two European risk prediction models, for identifying patients at high-risk of medication harm, in an Australian hospital setting. METHODS: This was a secondary analysis of a pre-existing cohort study described in a recently published study by Falconer et al. (Br J Clin Pharmacol 87(3):1512-1524, 2021) describing the development of a predictive risk model for inpatient medication harm. We retrospectively extracted relevant variables using the electronic health records of general medical and geriatric patients admitted to a quaternary hospital, in Brisbane, over 6 months from July to December 2017. This dataset was used to externally evaluate the two European models, The Brighton Adverse Drug Reaction Risk (BADRI) model by Tangiisuran et al. and a risk model developed by Trivalle et al. The variables were entered into both models and the patients' risk of medication harm was calculated, and compared with actual patient outcomes. Predictive performance was evaluated by measuring area under the receiver operative characteristic (AuROC) curves. RESULTS: The Australian patient cohort included 1982 patients (median age 74 years), of which 136 (7%) patients experienced ≥ 1 medication harm event(s). External evaluation of the two European models identified that both the BADRI and the Trivalle models had reduced predictive performance in an Australian patient cohort, compared with their original studies (AuROC of 0.63 [95% CI: 0.58-0.68] and 0.60 [95% CI: 0.55-0.65], respectively). CONCLUSION: Neither model demonstrated sufficient discrimination to warrant further evaluation in our local setting. This is likely a result of variations between the development and the validation cohorts, and the change in healthcare systems over time, and highlights the need for an up-to-date and context-specific risk prediction model.
PURPOSE: To externally evaluate the performance of two European risk prediction models, for identifying patients at high-risk of medication harm, in an Australian hospital setting. METHODS: This was a secondary analysis of a pre-existing cohort study described in a recently published study by Falconer et al. (Br J Clin Pharmacol 87(3):1512-1524, 2021) describing the development of a predictive risk model for inpatient medication harm. We retrospectively extracted relevant variables using the electronic health records of general medical and geriatric patients admitted to a quaternary hospital, in Brisbane, over 6 months from July to December 2017. This dataset was used to externally evaluate the two European models, The Brighton Adverse Drug Reaction Risk (BADRI) model by Tangiisuran et al. and a risk model developed by Trivalle et al. The variables were entered into both models and the patients' risk of medication harm was calculated, and compared with actual patient outcomes. Predictive performance was evaluated by measuring area under the receiver operative characteristic (AuROC) curves. RESULTS: The Australian patient cohort included 1982 patients (median age 74 years), of which 136 (7%) patients experienced ≥ 1 medication harm event(s). External evaluation of the two European models identified that both the BADRI and the Trivalle models had reduced predictive performance in an Australian patient cohort, compared with their original studies (AuROC of 0.63 [95% CI: 0.58-0.68] and 0.60 [95% CI: 0.55-0.65], respectively). CONCLUSION: Neither model demonstrated sufficient discrimination to warrant further evaluation in our local setting. This is likely a result of variations between the development and the validation cohorts, and the change in healthcare systems over time, and highlights the need for an up-to-date and context-specific risk prediction model.
Authors: Marzyeh Ghassemi; Tristan Naumann; Peter Schulam; Andrew L Beam; Irene Y Chen; Rajesh Ranganath Journal: AMIA Jt Summits Transl Sci Proc Date: 2020-05-30