Pragmatic estimates of the proportion of pediatric inpatients exposed to specific medications in the USA

PURPOSE: To provide pragmatic national estimates of the proportion of hospitalized pediatric patients exposed to specific drugs in the USA. METHODS: We used Premier Perspective Database and the Pediatric Health Information System data including specific drug exposures of 1.15 million inpatients <18 years old in 411 general and 52 children's hospitals throughout the USA in 2006, extrapolating this information into the probability-based Kids' Inpatient Database, which has demographic and clinical characteristics but no drug exposure data. We used a multivariable stratified resampling (MSR) technique to estimate the proportion of drug exposure for the 700 most commonly used drugs and performed additional stability and sensitivity analyses for 19 drugs. RESULTS: The estimated proportion of pediatric inpatients exposed to specific drugs in 2006 ranged from high levels such as that of acetaminophen (17.36; 95%CI: 17.32, 17.41) to rare exposures such as bosentan (0.0018; 95%CI: 0.0013, 0.0023). Additional analyses for 19 drugs revealed that the MSR estimates were close to estimates generated by multivariable multiple imputation, with a maximum absolute difference of 0.03 for acetaminophen (17.36 vs. 17.33) and famotidine (1.90 vs. 1.93), and that even with 50% of the hospitals removed at random, the proportion estimates did not vary by more than 2.5-fold at the upper 97.5 percentile. CONCLUSIONS: These pragmatic national estimates of the proportion of pediatric inpatient drug exposures, generated using an MSR technique, provide a context for interpretation of drug-related adverse event reports and prioritization of pediatric pharmacology research.