Association of the STOPP Criteria V2 and the Fall-Risk-Increasing Drugs List with Falls in Older Hospitalized Patients
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Association of the STOPP criteria v2 and the Fall-Risk-Increasing Drugs list with falls in older hospitalized patients Master thesis Medical Informatics Kimmy Raven, BSc 2 Project information Project information Author Kimberly (Kimmy) Raven, BSc. Student number: 11025913 [email protected] Mentor Birgit Damoiseaux-Volman, MSc. PhD student SCOPE study Department of Medical Informatics, Amsterdam University Medical Centers – location AMC [email protected] Tutor Dr. Danielle Sent – Assistant professor Department of Medical Informatics, Amsterdam University Medical Centers – location AMC [email protected] Location Department of Medical Informatics, Amsterdam University Medical Centers – location AMC Meibergdreef 9, 1105 AZ Amsterdam Period December 2019 – June 2020 Table of contents 3 Table of contents English summary ..................................................................................................................................... 4 Nederlandse samenvatting ..................................................................................................................... 5 1. Introduction ........................................................................................................................................ 6 1.1 Objective ....................................................................................................................................... 7 2. Methods .............................................................................................................................................. 8 2.1. STOPPs ......................................................................................................................................... 8 2.2. FRIDs ............................................................................................................................................ 8 2.3. Selection of falls ........................................................................................................................... 9 2.4. Data retrieval ............................................................................................................................. 10 2.5. Data analysis .............................................................................................................................. 10 3. Results ............................................................................................................................................... 12 3.1. STOPPs ....................................................................................................................................... 12 3.2. FRIDs .......................................................................................................................................... 12 3.3. Falls ............................................................................................................................................ 13 Univariate logistic regression ........................................................................................................ 15 Propensity score matching............................................................................................................ 16 4. Discussion .......................................................................................................................................... 19 5. Acknowledgement ............................................................................................................................ 22 6. References ........................................................................................................................................ 23 Appendix 1. Abbreviations .................................................................................................................... 26 Appendix 2. Selection process of study population .............................................................................. 27 Appendix 3. STOPPs .............................................................................................................................. 28 Appendix 4. Characteristics of the STOPPs ........................................................................................... 33 Appendix 5. Selected FRIDs ................................................................................................................... 36 Appendix 6. Characteristics of FRIDs .................................................................................................... 37 Appendix 7. Search queries used in CTcue ........................................................................................... 38 Appendix 8. Regular expressions for problemlist search ...................................................................... 40 Appendix 9: Characteristics of the study population ............................................................................ 41 Appendix 10. Characteristics of the population with and without STOPPs .......................................... 43 Appendix 11. Characteristics of the population with and without FRIDs ............................................. 45 Appendix 12. Legend for the different ICD-10 categories .................................................................... 47 4 English summary English summary Objective Falling amongst older persons is a growing problem, also during hospitalization. This is due to its high prevalence and related fatal and nonfatal injuries. The aim of this study is to identify the association between the STOPP criteria v2 and the FRIDs list on falling in older hospitalized patients using a large dataset of routinely collected, structured and unstructured EHR data of a cohort. Subjects Hospitalized patients of 70 years and older with a hospitalization duration of at least 24 hours, admitted between November 2015 up to November 2019. Methods A large dataset of hospitalizations of a university hospital was derived from the electronic health records. Identification of STOPP violations was performed by means of the Dutch STOPP-criteria v2. Identification of FRID administrations was performed by means of a European FRIDs list. Falls were identified by searching free-text nursing and physician notes and the list of running diagnoses and complications (known as the problemlist). Univariate logistic regression and doubly-robust propensity score matching was performed to analyze the risk that STOPP violations and FRID administrations pose on the occurrence of falls. Results Data included 16,823 hospital admissions for 11,354 patients. The median age of the population was 76, and 51.8% was male. In 56.7% of the hospitalizations one or more STOPP violations were registered. FRID administrations were registered in 82.9% of the hospitalizations. One or more falls occurred in 257 (1.5%) of the hospitalizations. We found that, among others, male gender, age, length of stay, fall history, and an elevated delirium risk score (DOSS >3) increase the risk of falling in older hospitalized patients. We also found a decrease in falls in case a single FRID was administered (OR: 0.0002 (0.0001 – 0.0003)) or a single STOPP was violated (OR: 0.0042 (0.0035 – 0.0050)). However, an increase in fall risk was found when 8 or more different FRIDs were administered (OR: 4.0606 (3.9245 – 4.2047) for each additional FRID administration) or 5 or more individual STOPPs were violated (OR: 4.4823 (4.3395 – 4.6325) for each additional STOPP violated). Conclusion Overall, a prevalence of 82.9% for FRID administrations and a prevalence of 56.7% for STOPP violations was found. Furthermore, we found both a FRID administration and a STOPP violation in 54.9% of the hospitalizations. Both FRID administrations and STOPP violations showed a reduced risk of falls. However, the number of FRIDs administered and STOPPs violated does seem to increase the risk of falling in older hospitalized patients. These results would suggest that not the FRID or STOPPs itself are harmful, but the total amount are. Further research, with a larger number of fallers is needed to pose more trustworthy results. Furthermore, future research should also look at individual STOPP criteria or FRIDs medications to determine the association for these individual medications of STOPP criteria. Keywords Hospital, STOPPs, FRIDs, accidental falls, older persons Nederlandse samenvatting 5 Nederlandse samenvatting Doelstelling Vallen onder ouderen is een groeiend probleem vanwege hoge prevalentie en gerelateerde fatale en niet-fatale verwondingen. Het doel van dit onderzoek is het identificeren van de correlatie tussen de schendingen van de STOPP criteria v2 en de toedieningen van medicatie van de FRIDs lijst op vallen bij oudere, in het ziekenhuis opgenomen, patiënten. Hierbij wordt gebruik wordt gemaakt van een grote dataset van gestructureerde en ongestructureerde data uit het elektronisch patiëntendossier. Populatie In het ziekenhuis opgenomen ouderen van 70 jaar en ouder, met een opnameduur van ten minste 24 uur, opgenomen tussen November 2015 en November 2019. Methode Voor dit onderzoek is een grote dataset van ziekenhuisopnamen uit het elektronisch patiënten dossier gebruikt. Schendingen van STOPP criteria zijn geïdentificeerd door middel van de Nederlandse STOPP criteria v2. De identificatie van toedieningen van FRID medicatie is gedaan door middel van een Europese FRIDs lijst. Vallen zijn geïdentificeerd door middel van het doorzoeken van vrij-tekst data (verpleegkundige notities en notities van de arts) en de lijst met lopende