Usefulness of ICD-10 diagnosis triggers to identify adverse drug events in emergency care. / Utilidad de los diagnósticos alertantes CIE-10 para identificar acontecimientos adversos por los medicamentos en los servicios de urgencias.

OBJECTIVES: To assess the usefulness of a tool based on ICD-10 diagnostic codes to identify patients who consult an emergency department for adverse drug events (ADE). METHODS: Prospective observational study, in which patients discharged from an emergency department during May to August 2022 with a diagnosis coded with one of the 27 ICD-10 diagnoses considered as triggers were included. ADE confirmation was carried out by analyzing drugs prescribed prior to admission, and through a discussion among experts and a phone interview with patients after hospital discharge. RESULTS: 1,143 patients with trigger diagnoses were evaluated, of which 310 (27.1%) corresponded to patients whose emergency visit was attributed to an ADE. A 58.4% of ADE consultations were found with three diagnostic codes: K59.0-Constipation (n = 87; 28.1%), I16.9-Hypertensive Crisis (n = 72; 23.2%) and I95.1-Orthostatic hypotension (n = 22; 7.1%). The diagnoses with the highest degree of association with consultations attributed to ADE were E16.2-Hypoglycemia, unspecified (73.7%) and E11.65-Type 2 diabetes mellitus with hyperglycemia (71.4%), while diagnoses D62-Acute posthemorrhagic anemia and I74.3-Embolism and thrombosis of arteries of the lower limbs were not attributed to any case of ADE. CONCLUSIONS: The ICD-10 codes associated with trigger diagnoses are a useful tool to identify patients who consult the emergency services with ADE and could be used to apply secondary prevention programs to avoid new consultations to the health care system.

Determination of meropenem in endotracheal tubes by in-tube solid phase microextraction coupled to capillary liquid chromatography with diode array detection.

Meropenem is a widely used antimicrobial for the treatment of infections associated with the use of invasive medical devices in intensive care unit patients. These treatments are not always effective, in fact, in-vitro studies have demonstrated the difficulty of antimicrobials to penetrate into the biofilm, however in-vivo studies of the effect of these compounds is a trend, mostly because of the complexity of pulmonary samples extracted from ETTs. Therefore, the objective of this study was to evaluate in-tube solid phase microextraction (in-tube SPME) coupled to capillary liquid chromatography (CapLC) with DAD to determine meropenem in ETTs in order to estimate the penetration capability into the biofilm. Firstly, different parameter affecting in-tube SPME, such as processed sample volume, capillary length, flow and capillary coating were studied. The best analytical response was achieved by processing 500 µL of standards/samples at 9 µL/seg with a 60-cm capillary column coated with 35%-diphenyl 65%-polydimethylsiloxane. Under these conditions, the analytical performance of in-tube SPME-CapLC-DAD, using acetonitrile-water in gradient mode as mobile phase, showed satisfactory results for estimation of meropenem in terms of sensitivity (LOD = 3 µg/L) and precision (RSD < 10%). Once the experimental conditions were stablished for in-tube SPME, the extraction of meropenem from the ETTs was studied. Liquid extraction, vortex-assisted liquid extraction (VALE) and ultrasound-extraction (UAE) extraction were tested. The results indicated that meropenem could be quantitatively extracted (91 ±â€¯6%) from ETTs, for its subsequent determination by in-tube SPME-CapLC-DAD using water as extraction solvent and 1 min as extraction time. Finally, samples from ETTs used for critically ill patients with different antimicrobial treatments were analysed with successful results.