title: Evaluation of Off-label Prescribing at a Children's Rehabilitation Center.
abstract: OBJECTIVE
  This study was developed to evaluate the incidence of off-label prescribing at a pediatric rehabilitation center. Secondary objectives were to describe the medications, patient age groups, and diagnoses most often associated with off-label prescribing.
  
  
  METHODS
  This was a prospective observational study conducted at an academic, inpatient children's rehabilitation center from November 11, 2011, to April 1, 2012. Patients younger than 16 years of age who received at least 1 prescription medication were included. Data were collected from the patients' electronic medical records.
  
  
  RESULTS
  A total of 240 medications orders were placed during the study, with 57% written off-label. Thirty-five patients (88%) received at least 1 off-label medication. Forty-nine percent of the orders were for patients younger than the approved range, with 48% written for an unapproved indication, 2% for an alternative route of administration, and 1% for an unapproved age and indication. Children 2 to 12 years of age received 40% of the off-label orders, followed by adolescents with 37%. The therapeutic classes most often prescribed off-label were central nervous system agents and anti-infectives.
  
  
  CONCLUSIONS
  Off-label prescribing was found in the majority of children receiving rehabilitative services, a rate as high or higher than that reported in pediatric acute care or clinic settings. The medications prescribed off-label most often were central nervous system agents, reflecting the need to study medications in the chronic rehabilitation population to optimize function in children with brain or spinal cord injury.
authors.affiliation: Department of Pharmacy Services, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Kyle E
authors.initials: KE
authors.lastname: Luedtke
authors.affiliation: Department of Pharmacy Services, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Buck
keywords: child; off-label; prescribing; rehabilitative services