Adverse Drug Event-Related Emergency Department Visits Associated With Complex Chronic Conditions

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Children who experience outpatient adverse drug events represent 0.5% of pediatric emergency department visits. The subset of children with complex chronic conditions often take multiple medications, but the incidence and severity of adverse drug events in these children is unknown. WHAT THIS STUDY ADDS:Children with complex chronic conditions have a higher risk of emergency department visits related to adverse drug events, compared with other children. The implicated drugs with the highest rates include psychotropic agents, antimicrobial agents, anticonvulsants, hormones/steroids, and analgesics. abstract BACKGROUND AND OBJECTIVES: Outpatient adverse drug events (ADEs) can result in serious outcomes requiring emergency department (ED) visits and hospitalizations. The incidence and severity of ADEs in children with complex chronic conditions (CCCs), who often take multiple medications, is unknown. We sought to describe the characteristics of ADE-related ED visits, including association with CCC status; determine the implicated medications; and determine if CCC status increased the risk of ADE-related admission. METHODS:Retrospective cohort study of ED visits by patients aged 0 to 18 years using a national sample. ADEs were identified by external cause of injury codes; cases with overdose, wrongful administration, self-harm, or diagnosis of malignancy were excluded. Multivariable logistic regression was used to test outcomes of having an ADE-related ED visit and of subsequent admission. All statistics accounted for the complex survey design. RESULTS:Of 144 million ED visits, 0.5% were associated with ADEs. Adjusting for age, gender, insurance type, day of week, and location of hospital, ADEs were associated with the presence of a CCC (odds ratio 4.76; 95% confidence interval: 4.45-5.10). The implicated medications differed significantly by CCC status. Adjusting for the same variables, ADEs were associated with subsequent inpatient admission (odds ratio 2.18; 95% confidence interval: 2.04-2.32) for all children; an interaction between ADE and CCC status was not significant.CONCLUSIONS: ED visits associated with ADEs were more likely to occur for children with CCCs, and the implicated drugs differed, but ADE-related admissions were not differentially affected by CCC status.

Families as Partners in Hospital Error and Adverse Event Surveillance

“…Patients with CCCs experience higher rates of errors and AEs owing to increased illness complexity and length of stay. 17,18,42,43 Their families may also be more activated or better understand the medical system, 44 making them particularly high-yield reporters. However, it is also important for hospitals to make concerted efforts to actively engage all families in safety reporting and, in particular, to engage less educated and other vulnerable populations.…”

Factors associated with involuntary hospital admissions in technology-dependent children

“…Among the drugs with the highest levels of adverse events were the psychotropics, the antimicrobials, the anticonvulsants, hormones/steroids and analgesics. Finally, the authors stated that little is known about the negative consequences of the use of these drugs in this client group, and that further studies are needed to understand the mechanisms that cause the increase in the risk of adverse events in the children with complex chronic conditions (17) . Another point of view dealt with in the international literature refers to errors in the administration of the drugs in the context of a complex therapy regimen.…”

Medication-Related Emergency Department Visits in Pediatrics: a Prospective Observational Study

“…Those studies that have been performed in pediatric patients have used retrospective design or significantly limited prospective methodologies, which preclude accurate determination of the magnitude of this issue. 16,[45][46][47][48][49][50][51][52][53][54][55] Retrospective evaluation, often conducted by using medical record review or use of administrative databases, has inherent limitation for reporting bias, challenges with event ascertainment, as well as causality and preventability assessment, and has reported much lower event rates compared with prospective studies. 11,56 Finally, no study has prospectively explored this issue in Canada, so the impact in our own country remains uncertain.…”