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Drug-related hospital admissions in older adults: comparison of the Naranjo algorithm and an adjusted version of the Kramer algorithm

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Key summary points

AbstractSection Aim

To evaluate the ability of the adjusted Kramer algorithm in adjudicating causality of drug-related admissions (DRAs) in geriatric inpatients.

AbstractSection Findings

The adjusted Kramer algorithm demonstrated a higher positive agreement with expert consensus (100%; 95% CI, 93.0–100%) in assessing DRA causality in geriatric inpatients compared to the Naranjo algorithm (72.3%; 95% CI, 59.6–82.3%).

AbstractSection Message

The maximal positive agreement with the expert consensus and the pragmatic nature of the adjusted Kramer algorithm support the implementation of this causality adjudication tool as part of a structured, step-based DRA assessment approach in older adults.

Abstract

Purpose

Drug-related admissions (DRAs) are an important cause of preventable harm in older adults. Multiple algorithms exist to assess causality of adverse drug reactions, including the Naranjo algorithm and an adjusted version of the Kramer algorithm. The performance of these tools in assessing DRA causality has not been robustly shown. This study aimed to evaluate the ability of the adjusted Kramer algorithm to adjudicate DRA causality in geriatric inpatients.

Methods

DRAs were assessed in a convenience sample of patients admitted to the acute geriatric wards of an academic hospital. DRAs were identified by expert consensus and causality was evaluated using the Naranjo and the adjusted Kramer algorithms. Positive agreement with expert consensus was calculated for both algorithms. A multivariable logistic regression analysis was performed to explore determinants for a DRA.

Results

A total of 218 geriatric inpatients was included of whom 65 (29.8%) experienced a DRA. Positive agreement was 72.3% (95% confidence interval (CI), 59.6–82.3%) and 100% (95% CI, 93.0–100%) for the Naranjo and the adjusted Kramer algorithm, respectively. Diuretics were the main culprits and most DRAs were attributed to a fall (n = 18; 27.7%). A fall-related principal diagnosis was independently associated with a DRA (odds ratio 20.11; 95% CI, 5.60–72.24).

Conclusion

The adjusted Kramer algorithm demonstrated a higher positive agreement with expert consensus in assessing DRA causality in geriatric inpatients compared to the Naranjo algorithm. Our results further support implementation of the adjusted Kramer algorithm as part of a standardized DRA assessment in older adults.

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Data availability

All data relevant to the research are included in the manuscript. Additional data are available from the authors upon reasonable request.

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Acknowledgements

The authors would like to thank Reini Mertens, employee of the hospital’s administration department, for coding the principal diagnoses and adverse drug reactions according to the International Statistical Classification of Diseases and Related Health Problems, tenth revision.

Funding

The authors have not received a specific grant for this research from any funding agency in the public, commercial or non-profit sectors.

Author information

Author notes

  1. Beatrijs Mertens and Julie Hias share the first authorship and contributed equally.

Authors and Affiliations

  1. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium

    Beatrijs Mertens, Julie Hias, Laura Hellemans, Isabel Spriet & Lorenz Roger Van der Linden

  2. Pharmacy Department, University Hospitals Leuven, Leuven, Belgium

    Beatrijs Mertens, Julie Hias, Laura Hellemans, Karolien Walgraeve, Isabel Spriet & Lorenz Roger Van der Linden

  3. Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium

    Jos Tournoy

  4. Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium

    Jos Tournoy

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  1. Beatrijs Mertens
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Contributions

Data collection and analysis: BM, JH, LH, KW, and LRVdL. Writing original manuscript: BM, JH, LH, KW, IS, JT, and LRVdL.

Corresponding author

Correspondence to Beatrijs Mertens.

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Conflict of interests

None declared.

Ethics approval

This study received ethical approval from the Ethics Research Committee of the Catholic University of Leuven and the University Hospitals Leuven (Belgium) via the Education-Support Committee for Biomedical Sciences (MP016458).

Consent to participate

Informed consent of the participants was not deemed necessary according to the Ethical Committee as drug-related admissions were evaluated as part of routine clinical practice.

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All the authors agreed with the publication of the research results.

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Mertens, B., Hias, J., Hellemans, L. et al. Drug-related hospital admissions in older adults: comparison of the Naranjo algorithm and an adjusted version of the Kramer algorithm. Eur Geriatr Med 13, 567–577 (2022). https://doi.org/10.1007/s41999-022-00623-7

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  • DOI: https://doi.org/10.1007/s41999-022-00623-7

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