Rates and causes of emergency department visits for adverse drug events

Data regarding adverse drug events in the United States could help to focus medication safety initiatives in outpatient settings.
Data regarding adverse drug events in the United States could help to focus medication safety initiatives in outpatient settings.

The rate of emergency department visits for adverse drug events is estimated to be 4 per 1,000 individuals between 2013 and 2014 in the United States, according to data published in JAMA.

The Patient Protection and Affordable Care Act of 2010 resulted in new programs that target adverse drug event prevention in hospitals, but adverse drug events still remain a public health and safety concern in outpatient settings. Updated representative data regarding adverse drug events in the United States could help to focus medication safety initiatives in these settings.

 

Nadine Shehab, PharmD, MPH, from the Division of Healthcare Quality Promotion at the US Centers for Disease Control and Prevention, and colleagues used public health surveillance data from 58 emergency departments participating in the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project to measure national weighted estimates of emergency department visits and hospitalizations for adverse drug events.

Using data from 42,585 cases, the researchers estimated that 4.0 emergency department visits per 1,000 individuals occurred annually between 2013 and 2014, and 27.3% of these visits resulted in hospitalization.

The researchers note that anticoagulants, antibiotics, and diabetes agents were implicated in approximately 46.9% of adverse drug events, including hemorrhage, moderate to severe allergic reactions, and hypoglycemia.

In addition, 34.5% of emergency department visits between 2013 and 2014 occurred among adults older than 65 years of age compared with 25.6% between 2005 and 2006. Older adults also experienced the highest hospitalization rates (43.6%). Anticoagulants, diabetes agents, and opioid analgesics were implicated in approximately 59.9% of adverse events for this patient population.

Antibiotics were the most common drug class implicated in adverse drug events among children younger than 5 years of age (56.4%) and among children and adolescents between 6 and 19 years of age (31.8%). Antipsychotics were the second most common drug class implicated in adverse events among children and adolescents between 6 and 19 years of age (4.5%).

“Improving recognition of adverse drug events by ED [emergency department] physicians is certainly important, but in the interim there is ample opportunity to improve patient safety by focusing attention on the adverse drug events consistently found to be common, serious, and measurable,” the study authors note.

“Targeting adverse drug events due to anticoagulants and diabetes agents in the inpatient setting has contributed to reductions in health care-related harm in US hospitals. Achieving measurable reductions in outpatient adverse drug events may also require focusing on the most common drugs implicated and the highest risk patients.”

Reference

  1. Shehab N, Lovegrove M, Geller AI, et al. US emergency department visits for outpatient adverse drug events, 2013-2014. JAMA. 2016;316(20):2115-2125. doi:10.1001/jama.2016.16201.
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