{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T21:20:31Z","timestamp":1760908831461,"version":"build-2065373602"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,4,16]],"date-time":"2013-04-16T00:00:00Z","timestamp":1366070400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2013,5]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Medical emergency teams have been shown to reduce mortality in children's hospitals, but there are many potential barriers to their activation. Surveillance tools using electronic health record data help identify children at risk of deterioration. Existing early warning scores primarily include vital signs, but may benefit from the incorporation of medications.<\/jats:p><\/jats:sec><jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>We aimed to identify the therapeutic classes of medications temporally associated with clinical deterioration that could be incorporated with vital signs into surveillance tools.<\/jats:p><\/jats:sec><jats:sec><jats:title>DESIGN<\/jats:title><jats:p>Case\u2010crossover study.<\/jats:p><\/jats:sec><jats:sec><jats:title>SETTING<\/jats:title><jats:p>The Children's Hospital of Philadelphia.<\/jats:p><\/jats:sec><jats:sec><jats:title>PATIENTS<\/jats:title><jats:p>Children with clinical deterioration, defined as cardiopulmonary arrest, acute respiratory compromise, or urgent intensive care unit transfer while hospitalized on pediatric wards (n\u2009=\u2009141).<\/jats:p><\/jats:sec><jats:sec><jats:title>EXPOSURES<\/jats:title><jats:p>Intravenous administrations of medications from therapeutic classes administered in \u22655% of control periods.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Nine therapeutic classes were significantly associated with clinical deterioration: glycopeptide antibiotics, anaerobic antibiotics, third\u2010generation and fourth\u2010generation cephalosporins, aminoglycoside antibiotics, systemic corticosteroids, benzodiazepines, loop diuretics, narcotic analgesics (full opioid agonists), and antidotes to hypersensitivity reactions.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>We identified a set of therapeutic classes associated with increased risk of clinical deterioration. Future work should focus on evaluating whether including these therapeutic classes in multivariable models improves their accuracy in detecting early, evolving deterioration. <jats:italic>Journal of Hospital Medicine<\/jats:italic> 2013;8:254\u2013260. \u00a9 2013 Society of Hospital Medicine<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhm.2042","type":"journal-article","created":{"date-parts":[[2013,4,16]],"date-time":"2013-04-16T00:38:42Z","timestamp":1366072722000},"page":"254-260","source":"Crossref","is-referenced-by-count":4,"title":["Medications associated with clinical deterioration in hospitalized children"],"prefix":"10.1002","volume":"8","author":[{"given":"Emily J.","family":"Huang","sequence":"first","affiliation":[{"name":"Division of General Pediatrics The Children's Hospital of Philadelphia Philadelphia Pennsylvania"},{"name":"School of Engineering and Applied Science University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher P.","family":"Bonafide","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics The Children's Hospital of Philadelphia Philadelphia Pennsylvania"},{"name":"Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia Philadelphia Pennsylvania"},{"name":"Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"},{"name":"Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron","family":"Keren","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics The Children's Hospital of Philadelphia Philadelphia Pennsylvania"},{"name":"Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia Philadelphia Pennsylvania"},{"name":"Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"},{"name":"Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinay M.","family":"Nadkarni","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia Philadelphia Pennsylvania"},{"name":"Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"},{"name":"Department of Anesthesia and Critical Care Medicine The Children's Hospital of Philadelphia Philadelphia Pennsylvania"},{"name":"Center for Simulation Advanced Education and Innovation The Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John H.","family":"Holmes","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,4,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000235743.38172.6E"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2009.12.008"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2010.10.013"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-39"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2011.04.012"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2011-000147"},{"issue":"5","key":"e_1_2_7_8_1","first-page":"1","article-title":"How RNs rescue patients: a qualitative study of RNs' perceived involvement in rapid response teams","volume":"19","author":"Leach LS","year":"2010","journal-title":"Qual Saf Health Care."},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2009532"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2005.016956"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-004-2268-7"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2044.2003.03331.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7422.1014"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2010.06.020"},{"volume-title":"Advances in Patient Safety: New Directions and Alternative Approaches","year":"2008","author":"Hueckel RM","key":"e_1_2_7_15_1"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280208092346"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(01)00404-8"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a115853"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.971"},{"key":"e_1_2_7_20_1","unstructured":"Lexicomp. 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