title: A systematic review of the performance characteristics of clinical event monitor signals used to detect adverse drug events in the hospital setting.
abstract: OBJECTIVE
  Despite demonstrated benefits, few healthcare organizations have implemented clinical event monitors to detect adverse drug events (ADEs). The objective of this study was to conduct a systematic review of pharmacy and laboratory signals used by clinical event monitors to detect ADEs in hospitalized adults.
  
  
  METHODS
  We performed a comprehensive search of MEDLINE, CINHAL and EMBASE to identify studies published between 1985 through 2006. Studies were included if they: described a clinical event monitor to detect ADEs in an adult hospital setting; described laboratory or pharmacy ADE signals; and, provided positive predictive values (PPVs) or information to allow the calculation of PPVs for individual ADE signals.
  
  
  METHODS
  We calculated overall estimates of PPVs and 95% confidence intervals (CIs) for signals reported in 2 or more studies and contained no evidence heterogeneity. Results were examined by signal category: medication levels, laboratory tests, or antidotes.
  
  
  RESULTS
  We identified 12 observational studies describing 36 unique ADE signals. Fifteen signals (3 antidotes, 4 medication levels, and 8 laboratory values) contained no evidence of heterogeneity. The pooled PPVs for these individual signals ranged from 0.03 [CI=0.03-0.03] for hypokalemia, to 0.50 [CI=0.39-0.61] for supratherapeutic quinidine level. In general, antidotes (range=0.09-0.11) had the lowest PPVs, followed by laboratory values (0.03-0.27), and medication levels (0.03-0.50).
  
  
  CONCLUSIONS
  Results from this study should help clinical information system and computerized decision support producers develop or improve existing clinical event monitors to detect ADEs in their own hospitals by prioritizing those signals with the highest PPVs [corrected]
authors: Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, 3471 Fifth Ave, Suite 500, Pittsburgh, PA 15213, USA. handlersm@upmc.edu
authors: Steven M
authors: SM
authors: Handler
authors: Richard L
authors: RL
authors: Altman
authors: Subashan
authors: S
authors: Perera
authors: Joseph T
authors: JT
authors: Hanlon
authors: Stephanie A
authors: SA
authors: Studenski
authors: James E
authors: JE
authors: Bost
authors: Melissa I
authors: MI
authors: Saul
authors: Douglas B
authors: DB
authors: Fridsma
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D020000:Decision Support Systems, Clinical; D016903:Drug Monitoring; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D008510:Medication Systems, Hospital; D017010:Reminder Systems