Kramer et al developed an algorithm for the diagnosis of an adverse drug reaction (ADR).
Patient selection: patient taking a drug
Parameters:
(1) previous experience with drug
(2) alternative illness able to explain findings (alternative explanation)
(3) timing of events
(4) drug levels
(5) dechallenge (improves if drug withdrawn)
(6) rechallenge
|
Parameter |
Finding |
Points |
|
previous experience |
favors |
1 |
|
|
uncertain |
0 |
|
|
against |
-1 |
|
alternative illness |
favors |
2 |
|
|
uncertain |
0 |
|
|
against |
-1 |
|
timing of events |
favors |
1 |
|
|
uncertain |
0 |
|
|
against |
-2 |
|
drug levels |
favors |
1 |
|
|
uncertain |
0 |
|
|
against |
1 |
|
Dechallenge |
favors |
1 |
|
|
uncertain |
0 |
|
|
against |
1 |
|
rechallange |
favors |
1 |
|
|
uncertain |
0 |
|
|
against |
1 |
where:
• Drug levels would be relevant for direct toxicity but not for an idiosyncratic reaction.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: -7
• maximum score: +7
• The higher the score the more likely that the patient is having an adverse drug reaction.
|
Total Score |
Adverse Drug Reaction |
|
< 0 |
unlikely |
|
0 to 3 |
possible |
|
4 or 5 |
probably |
|
6 or 7 |
definite |
Specialty: Toxicology, Emergency Medicine, Critical Care
