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ED visits for drug AEs more common in children with complex chronic conditions
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ED visits for adverse drug events are more common among children with complex chronic conditions, however, admissions were not differentially affected by complex chronic condition status, according to recent study findings published in Pediatrics.
James A. Feinstein, MD, MPH, of the Children’s Outcomes Research Program at Children’s Hospital Colorado, and colleagues evaluated more than 144 million ED visits among children aged 0 to 18 years to determine characteristics of adverse drug event (ADE)-related visits including complex chronic condition (CCC) status, implicated medications, and if CCC status increased ADE-related admission risk.
James A. Feinstein
ADEs were associated with 0.5% of all visits, and were associated with 2.2% of CCC-related visits compared with 0.5% of non-CCC-related visits.
Increased risk of an ADE-related visit were independently associated with increasing age, female gender, private insurance, weekend timing of the visit, regional location of the hospital and presence of a CCC. Fifty-six percent of participants with a CCC and ADE had a neuromuscular CCC, followed by cardiovascular (17%), hematologic/immunologic (11%), and metabolic (10%) classes. Twenty percent of the visits had multiple CCCs present.
The researchers also found that 18% of the ADE visits to the ED in patients with CCC were suspected to be caused by psychotropic medications followed by unclassified medications (13%), antimicrobial agents (12%), and anticonvulsants (11%). Thirty-nine percent of non-CCC-related ADE visits to the ED were suspected to be caused by unclassified medications (39%), followed by antimicrobial agents (29%), analgesics (5%), and vaccines (4%).
Forty-one percent of ADEs in patients seen in the ED were associated with antipsychotics compared with 26% in non-CCC visits. Twenty-eight percent of ADEs in CCC visits were associated with tranquilizers compared with 14% non-CCC visits. Thirty-percent of ADEs in non-CCC visits were associated with psychostimulants compared with 8% of CCC visits. Eighteen percent of ADEs in non-CCC visits were associated with antidepressants compared with 8% of CCC visits.
“Children with complex chronic conditions have a higher risk of ED visits related to ADEs, compared with other children,” the researchers wrote. “The implicated drugs are different, with the highest rates attributed to psychotropic agents, antimicrobial agents, anticonvulsants, hormonal/steroids, and analgesics.”
Researchers also reported that understanding the reasons for increased risk of ADEs among children with complex chronic conditions could improve pharmaceutical safety and reduce ADEs during the children’s lifetimes.
“This will allow for identification of certain risky drug exposures and dangerous drug-drug or drug-disease combinations, improvement in the management of and communication about complex drug regimens, and the development of enhanced monitoring strategies,” they wrote.
“All children who take medications are at risk of experiencing adverse drug events, but children with complex chronic conditions are particularly vulnerable; this demonstrates the need for careful management of their often complex medication regimens,” Feinstein concluded.
Disclosure: The researchers report no relevant financial disclosures.
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