title: Medications associated with clinical deterioration in hospitalized children.
abstract: BACKGROUND
  Medical emergency teams have been shown to reduce mortality in children's hospitals, but there are many potential barriers to their activation. Surveillance tools using electronic health record data help identify children at risk of deterioration. Existing early warning scores primarily include vital signs, but may benefit from the incorporation of medications.
  
  
  OBJECTIVE
  We aimed to identify the therapeutic classes of medications temporally associated with clinical deterioration that could be incorporated with vital signs into surveillance tools.
  
  
  METHODS
  Case-crossover study.
  
  
  METHODS
  The Children's Hospital of Philadelphia.
  
  
  METHODS
  Children with clinical deterioration, defined as cardiopulmonary arrest, acute respiratory compromise, or urgent intensive care unit transfer while hospitalized on pediatric wards (n = 141).
  
  
  METHODS
  Intravenous administrations of medications from therapeutic classes administered in ≥5% of control periods.
  
  
  RESULTS
  Nine therapeutic classes were significantly associated with clinical deterioration: glycopeptide antibiotics, anaerobic antibiotics, third-generation and fourth-generation cephalosporins, aminoglycoside antibiotics, systemic corticosteroids, benzodiazepines, loop diuretics, narcotic analgesics (full opioid agonists), and antidotes to hypersensitivity reactions.
  
  
  CONCLUSIONS
  We identified a set of therapeutic classes associated with increased risk of clinical deterioration. Future work should focus on evaluating whether including these therapeutic classes in multivariable models improves their accuracy in detecting early, evolving deterioration.
authors.affiliation: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Huang
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Bonafide
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: John H
authors.initials: JH
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D018592:Cross-Over Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006776:Hospitals, Pediatric / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D004364:Pharmaceutical Preparations / Q000008:administration & dosage / Q000145:classification*
chemical_list: D004364:Pharmaceutical Preparations