title: Potentially inappropriate medication use is associated with clinical outcomes in critically ill elderly patients with neurological injury.
abstract: BACKGROUND
  Limited data suggest that potentially inappropriate medications (PIMs) impact outcomes in critically ill elderly patients. No data are available on the association between PIM use as well as drug burden index (DBI), which is a measure of PIM use, and clinical outcomes in neurocritical care elderly patients. This study evaluates whether PIM use and a higher DBI are associated with poor clinical outcomes in neurocritical care elderly patients.
  
  
  METHODS
  PIMs were retrospectively identified in critically ill elderly patients admitted to the neuroscience intensive care unit (NSICU) from March to July 2011. DBI was calculated based on PIM doses. Relationships with clinical outcomes were evaluated.
  
  
  RESULTS
  PIMs were prescribed to a majority (81.3 %) of the 112 patients. Opioids were most commonly associated with a decrease in Richmond Agitation Sedation Scale (RASS) scores (56 % of PIM doses). Time to recovery was significantly longer in patients with a higher PIM burden (≤2 PIMs: 8 h, >2 PIMs: 29 h; p = 0.02). There was a significantly longer NSICU and hospital length of stay (9 vs 2; 15 vs 5 days; p < 0.0001) as well as a lower Glasgow Coma Scale score upon discharge (14 vs 15, p = 0.02) in patients with a higher DBI after 72 h of hospitalization. There was no difference in mortality.
  
  
  CONCLUSIONS
  PIM use and higher DBI scores were associated with poor clinical outcomes and longer lengths of stay. Further studies are needed to determine the impact of PIMs and DBI on mortality in neurocritical care elderly patients.
authors.affiliation: School of Pharmacy, Virginia Commonwealth University, 410 N. 12th Street, Richmond, VA, 23298-0533, USA, kileyc@vcu.edu.
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Floroff
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Slattum
authors.forename: Spencer E
authors.initials: SE
authors.lastname: Harpe
authors.forename: Perry
authors.initials: P
authors.lastname: Taylor
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Brophy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D001930:Brain Injuries; D002543:Cerebral Hemorrhage; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D015600:Glasgow Coma Scale; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D020521:Stroke
chemical_list: D000701:Analgesics, Opioid; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists; D006635:Histamine H2 Antagonists; D009466:Neuromuscular Blocking Agents; D001569:Benzodiazepines