Study Examines Rates, Causes of ED Visits for Adverse Drug Events

Authors find increase in visits due to anticoagulants and antidiabetic agents

The prevalence of emergency department (ED) visits for adverse drug events (ADEs) in the United States was estimated to be four per 1,000 individuals in 2013 and 2014, and the most common drug classes involved were anticoagulants, antibiotics, diabetes agents, and opioid analgesics, according to a new study published in the Journal of the American Medical Association.

ADEs have recently received attention in national patient safety initiatives. The Patient Protection and Affordable Care Act of 2010 created new programs that target the prevention of ADEs in hospitals and during care transitions between inpatient and outpatient settings. Nationally representative data describing ADEs can help focus these efforts, according to the authors.

Nadine Shehab, PharmD, MPH, and her colleagues at the Centers for Disease Control and Prevention examined characteristics of ED visits for ADEs in the United States in 2013–2014 and changes in ED visits for ADEs since 2005–2006. The researchers analyzed nationally representative data from 58 EDs located in the U.S. and participating in the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project.

Based on data from 42,585 cases, an estimated four ED visits for ADEs occurred per 1,000 individuals annually in 2013 and 2014, and 27% of ED visits for ADEs resulted in hospitalization. An estimated 35% of ED visits for ADEs occurred among adults 65 years of age or older in 2013–2014 compared with an estimated 26% in 2005–2006; older adults experienced the highest hospitalization rate (44%).

Anticoagulants, antibiotics, and diabetes agents were implicated in an estimated 47% of ED visits for ADEs, which included clinically significant adverse events, such as hemorrhage (anticoagulants), moderate-to-severe allergic reactions (antibiotics), and hypoglycemia with moderate-to-severe neurologic effects (diabetes agents). Since 2005–2006, the proportions of ED visits for ADEs from anticoagulants and diabetes agents have increased, whereas the proportion from antibiotics has decreased, the authors found.

Among children 5 years of age or younger, antibiotics were the most common drug class implicated (56%). Among children and adolescents 6 to19 years of age, antibiotics also were the most common drug class implicated (32%) in ED visits for ADEs, followed by antipsychotics (4.5%).

Among older adults (65 years of age and older), three drug classes––anticoagulants, diabetes agents, and opioid analgesics––were implicated in an estimated 60% of ED visits for ADEs; four anticoagulants (warfarin, rivaroxaban, dabigatran, and enoxaparin) and five diabetes agents (insulin and four oral agents) were among the 15 most common drugs implicated. Medications to always avoid in older adults, according to Beers criteria, were implicated in 1.8% of ED visits for ADEs.

“Targeting adverse drug events common among specific patient populations, such as among the youngest (age 19 years or less) and oldest (age 65 years and older), may help further focus outpatient medication safety efforts,” the authors write.

In an accompanying editorial, Chad Kessler, MD, MHPE, of the Durham VA Medical Center in Durham, North Carolina, and colleagues write:

“The question remains how to best leverage the existing system to improve the safety of the process of starting, monitoring, and discontinuing medications.

“Collaboration is needed among physicians and other health professionals in primary care, specialty care, pharmacy, and emergency medicine to answer these questions in the quest for safer models of patient care. Furthermore, this collaboration across health care locations and the continuum of care will affect how much benefit or harm patients receive from prescribed medications. Integrated health care systems can help lead the way through improved care coordination and transition of care models. The work by Shehab et al. shines a spotlight on the problem of adverse drug events and highlights the need to address this important clinical issue in a more systematic and organized fashion.”

Source: JAMA Network; November 22, 2016.