November 16, 2016

US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014

Shehab, N., et al, JAMA 316(20):2115, November 22, 2016

METHODS: This retrospective study coordinated at the Centers for Disease Control and Prevention catalogued adverse drug events occurring in 42.585 visits to 58 EDs in 2013-2014 as a result of drug exposures (excluding recreational use). Data were derived from a nationally representative US public health surveillance database. The primary study outcomes were national weighted estimates of ED visits and subsequent hospitalizations in 2013-2014, and changes from 2005-2006.

RESULTS: The most common type of adverse event was supratherapeutic dosing (37.2% of ED visits). There were 4.0 ED visits for adverse drug events per 1000 patients per year in 2013-2014, and 27.3% of visits resulted in hospitalization. Adults aged 65 and older accounted for 34.5% of ED visits and 43.6% of hospitalizations in 2013-2014; the rate of ED visits increased from 25.6% in 2005-2006. The primary implicated drug classes overall were anticoagulants, systemic antibiotics, and diabetes agents, together accounting for 46.9% of all ED visits; respective adverse events were hemorrhage (79.4% of visits), allergic reactions (18.2%), and hypoglycemia with neurologic effects (47.6%). Antibiotics were the most commonly implicated drug class in patients aged five years or younger (56.4% of the total) and in patients aged 6-19 years (31.8%). For adults aged 65 or older, anticoagulants, diabetes agents and opioids were suspected in 59.9% of ED visits. Proportions of ED visits due to anticoagulants and antidiabetics increased from 2005-2006 to 2013-2014, while the proportion due to antibiotics decreased.

CONCLUSIONS: Further safety initiatives are needed for prescription of anticoagulants, antibiotics, diabetes agents and opioids. 42 references ( – no reprints)

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