title: Predicting the Risk of Adverse Drug Reactions in Older Inpatients: External Validation of the GerontoNet ADR Risk Score Using the CRIME Cohort.
abstract: Adverse drug reactions (ADRs) in older people are often preventable, indicating that screening and prevention programs aimed at reducing their rate are needed in this population.
  
  
  
  The aim of this study was to externally validate the GerontoNet ADR risk score and to assess its validity in specific subpopulations of older inpatients.
  
  
  
  Data from the prospective CRIteria to assess appropriate Medication use among Elderly complex patients (CRIME) cohort were used. Dose-dependent and predictable ADRs were classified as type A, probable or definite ADRs were defined according to the Naranjo algorithm, and diagnostic accuracy was tested using receiver operating characteristic (ROC) analyses. Sensitivity and specificity were calculated for a cut-off point of 4.
  
  
  
  The mean age of the 1075 patients was 81.4 years (standard deviation 7.4) and the median number of drugs was 10 (range 7-13). At least one ADR was observed in 70 patients (6.5%); ADRs were classified as type A in 50 patients (4.7%) and defined as probable or definite in 41 patients (3.8%). Fair diagnostic accuracy to predict both type A and probable or definite ADRs was found in subpopulations aged <70 or ≥80 years with heart failure, diabetes, or a previous ADR. Good accuracy to predict type A ADRs was found in patients with a low body mass index (BMI; >18.5 kg/m2) and a Mini-Mental State Examination (MMSE) score of >24/30 points, as well as in patients with osteoarthritis. The cut-off point of 4 points yielded very good sensitivity but poor specificity results in these subpopulations.
  
  
  
  This study suggests that the GerontoNet ADR risk score might represent a pragmatic approach to identifying specific subpopulations of older inpatients at increased risk of an ADR with a fair to good diagnostic accuracy.
authors.affiliation: Department of Internal Medicine, Section of Geriatrics, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. mirko.petrovic@ugent.be.
authors.forename: Mirko
authors.initials: M
authors.lastname: Petrovic
authors.affiliation: School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia.
authors.forename: Balamurugan
authors.initials: B
authors.lastname: Tangiisuran
authors.affiliation: Department of Medicine, Brighton and Sussex Medical School, Brighton, England, UK.
authors.forename: Chakravarthi
authors.initials: C
authors.lastname: Rajkumar
authors.affiliation: Department of Internal Medicine (Geriatrics), Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.
authors.forename: Tischa
authors.initials: T
authors.lastname: van der Cammen
authors.affiliation: Department of Geriatrics (Policlinico A. Gemelli), Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000592:standards* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity