Triggers and Targeted Injury Detection Systems (TIDS) Expert Panel Meeting: Conference Summary Report

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Figure 1. Frequency of triggers linked to specific adverse drug events

Figure 1 presents the frequency of triggers linked to specific ADEs. There are 23 triggers linked to a bleeding ADE; 22 triggers linked to hepatotoxicity; 19 triggers each for renal insufficiency/toxicity and hyperkalemia; and 17 triggers linked to an allergic reaction to a drug. These triggers are the most prevalent. Next in the list is 10 triggers linked to ADEs that include clostridium difficile colitis, diarrhea or constipation. There are also 10 triggers each for bleeding with a high INR ADEs and allergic reactions with rash, itching or hives. Hypoglycemia and gastritis, upper GI bleed, GI perforation, GI ulcer and/or anemia have nine triggers each. There are eight triggers for overdose ADEs, as well as eight triggers for bleeding associated with anticoagulation and anticonvulsant toxicity. Digoxin toxicity and antidepressant complications have seven triggers each. There are six triggers each for phenytoin toxicity, hyperglycemia, digoxin toxicity associated with bradycardia and delirium. There are also six triggers each for diarrhea, and blood dyscrasias/thrombocytopenia. The last three ADEs have five triggers each: hypokalemia, hematoxicity, and theophylline toxicity.

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Figure 2. Frequency of triggers linked to specific medical management adverse events

$Figure 2 presents the frequency of triggers linked to medical mismanagement AEs. The most frequent triggers are associated with respiratory failure, mental status changes, intravenous catheter infection, and decubitus ulcer – each have seven triggers. The following AEs have six triggers each: nosocomial infection and hypotension. There are five triggers each associated with fluid overload/iatrogenic pulmonary edema and central venous catheter infections. Renal insufficiency/toxicity, medical device complications, fall and/or hip fracture and/or other bone fracture or break have four triggers each. There are also four triggers for cardiopulmonary arrest. Unplanned admissions have three triggers. The last several AEs have two triggers apiece: seizure, pulmonary embolism, pediatric cardiovascular AEs, deep vein thrombosis or emboli, and aspiration pneumonia/pneumonitis.$

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Figure 3. Frequency of triggers linked to surgical adverse events

Figure 3 shows the frequency of triggers linked to surgical AEs. The most prevalence surgical AEs with 10 triggers associated are operative or procedural complications. There are five triggers associated with post-operative complications, and three triggers for an unplanned surgery. Postoperative wound infection, postoperative wound dehiscence and anastomatic leak each have two triggers. The following AEs have one trigger each: unnecessary surgical procedure, laproscopic unplanned conversion, foreign body, deep vein thrombosis or emboli, death or serious injury, circumcision requiring repair and cardiac arrest.

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Figure 4. Frequency of triggers linked to adverse drug event causal agent

Figure 4 shows the frequency of triggers linked to an ADE's causal agent. There are 49 triggers that look at the administration of antibiotics to detect ADEs. Forty-three triggers use anticoagulants as ADE causal agents. There are 24 triggers that identify anticonvulsants as the causal agent of interest and 22 triggers that look at non-opioid analgesics. Twenty-one triggers use glucose controllers as the causal agent. There are 16 triggers for potassium raisers and 15 for digoxin and antidepressants. Thirteen triggers are associated with psychotropic and antiarrhythmic causal agents. There are nine triggers for opioid and ACE-I/ARB ADE causal agents and eight triggers for antihypertensive drugs. Theophylline, statins, immunosuppressants, hormones and diuretics have six triggers each. There are five triggers for corticosteroids and three each for potassium reducers and H2 blockers. Surgical events are a causal agent in two triggers for ADEs. There are also two triggers each for hepatotoxins, GI, cardiovascular, antipsychotic and anticholinergic drugs.

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