An analysis of emergency department visits for outpatient adverse drug events

1. The prevalence of emergency department visits for adverse drug events in the United States was estimated to be 4 per 1000 individuals in 2013 and 2014.

2. The most common drug classes implicated were anticoagulants, antibiotics, diabetes agents, and opioid analgesics.

Evidence Rating Level: 2 (Good)       

Study Rundown: Outpatient adverse drug events have caught recent national attention. Many patients in ambulatory care settings have complex medication regimens with less monitoring compared to hospitalized patients. The purpose of this national public health surveillance project was threefold: 1) to describe emergency department (ED) visits for adverse drug events in 2013-2014, 2) to compare the results to those obtained in 2005-2006, and 3) to better understand and promote outpatient medication safety initiatives.

The authors found that for every 1000 patient visits to an ED, 4 were related to an adverse drug events. Compared to 2005-2006 the same classes of drugs were most commonly implicated in ED visits in 2013-2014, namely anticoagulants, antibiotics, diabetic medications, and opioid analgesics. ED visits related to adverse events from anticoagulants and diabetes increased, compared to antibiotic adverse events which decreased.

Though this study analyzes the current state of adverse effects of outpatient medication that require ED care, there are a number of important limitations to consider. First, only adverse events diagnosed and treated in EDs were included, thus this study did not evaluate patients with adverse events that reported to alternative settings—likely those that were low-severity or of more insidious onset. Additionally, fatal adverse medication events may not be included depending on the specific practices of each ED. What’s more these estimates do not include visits related to pharmaceutical abuse or self-harm attempts.

Click to read the study, published today in JAMA

Relevant Reading: National Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events

In-Depth [public health surveillance]: Data from 58 EDs in the United States, including a total of 42,585 cases, showed an estimated annual rate of ED visits for adverse drug events of 4 per 1000 in 2013 and 2014 (95% CI, 3.1-5.0). Of these ED visits, 27.3% (95% CI, 22.2%-32.4%) resulted in hospitalization. Compared to 2005-2006 a greater proportion of ED visits were for adverse events among adults aged > 65 years old (34.5% vs 25.6%).

The main culprits of ED visits, accounting for a total of 46.9% of visits were anticoagulants, antibiotics, and diabetes agents (95% CI, 44.2%-49.7%). Comparing trends from 2005-2006 to 2013-2014, the proportion of ED visits for adverse drug events from anticoagulants and diabetes agents have increased, whereas the proportion from antibiotics has decreased. Importantly, among adults aged older than 65 years, 59.9% of ED visits were from 3 drug classes (anticoagulants, diabetes agents, and opioid analgesics). Medications on Beers criteria list accounted for 1.8% (95% CI, 1.5%-2.1%) of ED visits for adverse drug events.


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