Background identifying drug-related hospital admissions (DRAs) in older people is difficult. A standardised chart review procedure has recently been developed. It includes an adjudication team (physician and pharmacist) screening using 26 triggers and then performing causality assessment to determine whether an adverse drug event (ADE) occurred (secondary to an adverse drug reaction, overuse, misuse or underuse) and whether the ADE contributed to hospital admission (DRA). Objective to assess the performance of those triggers in detecting DRA. Design retrospective study using data from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people) trial. Settings four European medical centres. Subjects multimorbid (≥ 3 chronic medical conditions) older (≥ 70 years) inpatients with polypharmacy (≥ 5 chronic medications) were enrolled in the OPERAM trial (N = 2,008) and followed for 12 months. We included patients with ≥1 adjudicated hospitalisation during the follow-up. Methods the positive predictive value (PPV; number of DRAs identified by trigger/number of triggers) was calculated for each trigger and for the tool as a whole. Results of 1,235 hospitalisations adjudicated for 832 patients, 716 (58%) had at least one trigger; an ADE was identified in 673 (54%) and 518 (42%) were adjudicated as DRAs. The overall PPV of the trigger tool for detecting DRAs was 0.66 [0.62–0.69]. Conclusions this tool performs well for identifying DRAs in older people. Based on our results, a revised version of the tool was proposed but will require external validation before it can be incorporated into research and clinical practice.

中文翻译：

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用于检测老年人药物相关住院情况的触发工具的性能：来自 OPERAM 试验的分析

背景确定老年人与药物相关的入院 (DRA) 是困难的。最近开发了一个标准化的图表审查程序。它包括一个裁决团队（医师和药剂师）使用 26 个触发因素进行筛查，然后进行因果关系评估以确定是否发生药物不良事件 (ADE)（继发于药物不良反应、过度使用、滥用或使用不足）以及 ADE 是否有助于住院（DRA）。目的是评估这些触发器在检测 DRA 中的性能。使用来自 OPERAM（优化治疗以防止多病老年人可避免住院）试验的数据设计回顾性研究。设置四个欧洲医疗中心。受试者多病态（≥ 3 种慢性疾病）年龄较大（≥ 70 岁）住院患者使用多种药物（≥ 5 种慢性药物）被纳入 OPERAM 试验（N = 2,008）并随访 12 个月。我们纳入了随访期间≥1 次裁定住院的患者。方法 计算每个触发器和整个工具的阳性预测值（PPV；由触发器识别的 DRA 数/触发器数）。对 832 名患者的 1,235 次住院进行了裁定，其中 716 名 (58%) 至少有一个触发因素；在 673 例（54%）中发现 ADE，518 例（42%）被判定为 DRA。用于检测 DRA 的触发工具的总体 PPV 为 0.66 [0.62–0.69]。结论 该工具在识别老年人中的 DRA 方面表现良好。根据我们的结果，