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Adverse drug events account for 8% of pediatric ED visits
Adverse medication-related causes were found in 8% of pediatric ED visits, of which 65% were considered potentially preventable, according to recent findings.
Furthermore, children who presented to the ED due to medication-related issues were more likely to be admitted to the hospital and have a longer length of stay, researchers noted.
“It has been estimated that adverse drug events account for over 17 million ED visits and 8.7 million hospital admissions annually in the United States,” Peter J. Zed, BSc, BSc(Pharm), ACPR, PharmD, from the University of British Columbia, and colleagues wrote. “A cost-of-illness model estimated that between 1995 and 2000 costs associated with morbidity and mortality secondary to adverse drug events more than doubled from $76.6 billion to more than $177.4 billion and is likely even higher today.”
Zed and colleagues evaluated 2,028 pediatric patients who presented to the ED of a pediatric tertiary care center in Halifax, Nova Scotia. Patients (mean age, 6.1 years; 47.4% female) were seen from November 2011 through October 2012.
The researchers interviewed patients and their families regarding their presenting complaint, history of the present illness, medical and medication history, and allergy status. ED visits were classified as medication-related if they pertained directly to: adverse drug reaction, drug interaction, improper drug selection, untreated indication, subtherapeutic dosage, supratherapeutic dosage, nonadherence or drug use without indication.
The researchers followed the patients until ED or hospital discharge and were contacted 30 days after discharge for status. They wrote that 163 patients (8%; 95% CI, 7%-9.3%) presented with a medication-related visit, of which 106 (65%; 95% CI, 57.2%-72.3%) were classified as preventable. The severity of these cases included:
- mild: 14 cases (8.6%; 95% CI, 4.8%-14%);
- moderate: 140 cases (85.9%; 95%CI, 79.6%-90.8%); and
- severe: nine cases (5.5%; 95% CI, 2.6%-10.2%).
The most prevalent types of medication-related visits pertained to adverse drug reactions (26.4%; 95% CI, 19.8%-33.8%); subtherapeutic dosage (19%; 95% CI, 13.3%-25.9%) and nonadherence (17.2%; 95% CI, 11.7%-23.9%).
There was a significantly greater likelihood of hospital admission among patients presenting with a medication-related visit vs. those with other presentations (OR = 6.5%; 95% CI, 4.3-9.6). Among those admitted, patients with medication-related visits had a longer median length of stay (3 days vs. 1.5 days; P = .02).
“Due to the heterogeneous nature of adverse medication-related events we identified, interventions should focus on those that are most prevalent and where evidence exists to support a preventive strategy,” Zed and colleagues wrote. “The optimal strategy may involve interventions outside the hospital to improve prescribing practices and monitoring, particularly in high-risk patients or high-risk medications.”
Disclosure: The researchers report no relevant financial disclosures.
