To identify trigger tools applied to detect adverse drug events (ADEs) in older people and describe their utility and performance. A systematic review was conducted in the PubMed, Lilacs, and Scopus databases (January 2024). Studies that developed, applied, or validated trigger tools and evaluated their utility and/or performance for detecting ADEs in older people were considered. Direct proportion meta-analyses using the inverse-variance method were performed for prevalence of ADEs and positive predictive value (PPV). Twenty-four studies (25 publications) were included. Twelve trigger tools were identified, of which six were developed for detecting ADEs in older population, four developed for general population and modified for older people, and two developed for general population. No tools for detecting ADEs in older people receiving palliative care or hospitalized in intensive or surgical care units were found. The performance of triggers was presented through PPV (11.5–71%), negative predictive values (83.3%), and sensitivity (30–94.8%). The overall PPV was 33.3% (95%CI: 32.5–34.2%). Triggers with good performance were changes in plasma levels of digoxin, glucose, and potassium; changes in international normalized ratio; abrupt medication stop; hypotension; and constipation. The prevalence of ADEs ranged from 2.8 to 66%, with overall prevalence of ADEs of 20% (95%CI: 19.3–20.8%). Preventability ranged from 8.4 to 94.4%. Metabolic or electrolyte disturbances induced by diuretics, constipation induced by opioids, and falls and delirium induced by benzodiazepines were the most prevalent ADEs. The trigger tools are flexible and easy to apply, and they can contribute to the detection of ADEs, their associated risk factors, the level of harm, and preventability in different health settings. However, there is no consensus on good or poor values of PPV, which indicate the performance of triggers. Furthermore, there is limited evidence regarding the evaluation of performance through negative predictive value, sensitivity, and specificity. CRD42022379893.

中文翻译：

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应用触发工具检测老年人药物不良事件：系统评价和荟萃分析

确定用于检测老年人药物不良事件 (ADE) 的触发工具并描述其实用性和性能。在 PubMed、Lilacs 和 Scopus 数据库中进行了系统评价（2024 年 1 月）。考虑了开发、应用或验证触发工具并评估其在老年人中检测 ADE 的效用和/或性能的研究。使用逆方差方法对 ADE 发生率和阳性预测值 (PPV) 进行直接比例荟萃分析。纳入了 24 项研究（25 篇出版物）。确定了 12 种触发工具，其中 6 种是为检测老年人群中的 ADE 而开发的，四种是为一般人群开发并针对老年人进行修改的，还有两种是为一般人群开发的。没有发现任何工具可以检测接受姑息治疗或住院重症或外科监护病房的老年人的 ADE。触发因素的表现通过 PPV (11.5–71%)、阴性预测值 (83.3%) 和敏感性 (30–94.8%) 来呈现。总体 PPV 为 33.3%（95%CI：32.5–34.2%）。表现良好的触发因素是血浆地高辛、葡萄糖和钾水平的变化；国际标准化比率的变化；突然停止用药；低血压;和便秘。 ADE 的患病率为 2.8% 至 66%，ADE 的总体患病率为 20%（95%CI：19.3-20.8%）。预防率范围为 8.4% 至 94.4%。利尿剂引起的代谢或电解质紊乱、阿片类药物引起的便秘以及苯二氮卓类药物引起的跌倒和谵妄是最常见的 ADE。触发工具灵活且易于应用，有助于检测 ADE、其相关风险因素、危害程度以及不同健康环境中的可预防性。然而，对于表明触发器性能的 PPV 值的好坏尚未达成共识。此外，关于通过阴性预测值、敏感性和特异性来评估表现的证据有限。 CRD42022379893。