Prevalence of polypharmacy exposure among hospitalized children in the United States

Abstract

Objective: To assess the prevalence and patterns of exposure to drugs and therapeutic agents among hospitalized pediatric patients.

Design: Retrospective cohort study.

Setting: A total of 411 general hospitals and 52 children's hospitals throughout the United States.

Patients: A total of 587 427 patients younger than 18 years, excluding healthy newborns, hospitalized in 2006, representing one-fifth of all pediatric admissions in the United States.

Main outcome measures: Daily and cumulative exposure to drugs and therapeutic agents.

Results: The most common exposures varied by patient age and by hospital type, with acetaminophen, albuterol, various antibiotics, fentanyl, heparin, ibuprofen, morphine, ondansetron, propofol, and ranitidine being among the most prevalent exposures. A considerable fraction of patients were exposed to numerous medications: in children's hospitals, on the first day of hospitalization, patients younger than 1 year at the 90th percentile of daily exposure to distinct medications received 11 drugs, and patients 1 year or older received 13 drugs; in general hospitals, 8 and 12 drugs, respectively. By hospital day 7, in children's hospitals, patients younger than 1 year at the 90th percentile of cumulative exposure to distinct distinct medications had received 29 drugs, and patients 1 year or older had received 35; in general hospitals, 22 and 28 drugs, respectively. Patients with less common conditions were more likely to be exposed to more drugs (P = .001).

Conclusion: A large fraction of hospitalized pediatric patients are exposed to substantial polypharmacy, especially patients with rare conditions.