Medications for Children Receiving Intensive Care: A National Sample

Abstract

OBJECTIVE: To examine medication administration records through electronic health record data to provide a broad description of the pharmaceutical exposure of critically ill children. DESIGN: Retrospective cohort study using the Cerner Health Facts database. SETTING: United States. PATIENTS: A total of 43,374 children 7 days old to less than 22 years old receiving intensive care with available pharmacy data. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 907,440 courses of 1,080 unique medications were prescribed with a median of nine medications (range, 1-99; 25-75th percentile, 5-16) per patient. The most common medications were acetaminophen, ondansetron, and morphine. Only 45 medications (4.2%) were prescribed to more than 5% of patients, and these accounted for 442,067 (48.7%) of the total courses of medications. Each additional medication was associated with increased univariate risk of mortality (odds ratio, 1.05; 95% CI, 1.05-1.06; p < 0.001). CONCLUSIONS: Children receiving intensive care receive a median of nine medications per patient and one quarter are prescribed at least than 16 medications. Only 45 medications were prescribed to more than 5% of patients, but these accounted for almost half of all medication courses.