Uncovering Medication Errors Leading to Hospital Admissions in the Emergency Department: An External, Prospective Validation of Clinical Decision Rules

Purpose Drug‐related admissions (DRAs) remain highly prevalent and are linked with increased morbidity and mortality. Rapid and accurate identification is key to both their acute management and secondary prevention. To this end, two clinical decision rules (CDRs) were recently developed to identify the causal adverse drug event (ADE‐CDR) or the underlying adverse drug reaction (ADR‐CDR). The aim of this study was to assess the diagnostic accuracy of both CDRs in a new patient cohort. Methods A prospective, cross‐sectional study was conducted at the emergency department (ED) of the University Hospitals Leuven in Belgium. Adult patients were included if admitted to the hospital via the ED. DRA was adjudicated by team consensus and compared to both ADE‐CDR and ADR‐CDR. Diagnostic accuracy was determined, and multivariable logistic regression was used to explore risk factors for DRAs. Results From 1 October 2018 to 26 September 2019, 438 patients were included, 58 (13.2%) of whom incurred a DRA. ADE‐CDR had a sensitivity of 89.7% and a specificity of 22.4%. The sensitivity and specificity of ADR‐CDR were 46.6% and 60.8%, respectively. Two risk factors were found for DRA: the presence of ≥ 1 comorbidity (odds ratio (OR) 4.71, 95% confidence interval (CI): 1.42–15.49) and ambulance transport (OR 2.16, 95% CI: 1.21–3.82). Conclusion ADE‐CDR showed a high sensitivity. In terms of specificity, both CDRs were unable to rule in DRAs in our setting. Conversely, the ADE‐CDR showcased the potential to rule out DRAs.