Assessment of adverse drug event recognition by emergency physicians in a French teaching hospital

Roulet, Lucien; Ballereau, F.; Hardouin, Jean-Benoît; Chiffoleau, Anne; Moret, L.; Potel, G.; Asseray, Nathalie

doi:10.1136/emermed-2011-200482

Cited by 35 publications

(56 citation statements)

References 24 publications

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“…), they are generally not inappropriate in this subset. Roulet et al (2013) estimated the frequency and the severity of drug-related visits in ED, in order to assess ADE recognition by emergency physicians (October 2007-31 March 2008. In their prospective cross-sectional single centre study in France, a total of 95 out of 423 eligible patients experienced an ADE.…”

Section: Discussionmentioning

confidence: 99%

Italian Emergency Department Visits and Hospitalizations for Outpatients’ Adverse Drug Events: 12-Year Active Pharmacovigilance Surveillance (The MEREAFaPS Study)

et al. 2020

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hospitalization were preventable. Anticoagulants, antibiotics, and nonsteroidal antiinflammatory drugs (NSAIDs) were the most frequently implicated agents for ED visits and/or hospitalization, which included clinically significant ADEs, such as haemorrhage for anticoagulants, moderate to severe allergic reactions for antibiotics, and dermatologic reactions and gastrointestinal disturbances for NSAIDs. Older age (1.54 [1.48-1.60]), higher number of concomitantly taken drugs (2.22 [2.14-2.31]), the presence of drugdrug interactions (1.52 [1.28-1.81]), and therapeutic error (1.54 [1.34-1.78]), were significantly associated with an increased risk of hospitalization. Conclusion: Our long-term active pharmacovigilance study in ED provided a valid estimation of ADE-related hospitalization in a representative sample of the Italian general population and can suggest further focus on medication safety in outpatients, in order to early recognise and prevent ADEs.

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Section: Discussionmentioning

confidence: 99%

Italian Emergency Department Visits and Hospitalizations for Outpatients’ Adverse Drug Events: 12-Year Active Pharmacovigilance Surveillance (The MEREAFaPS Study)

et al. 2020

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“…Indeed, many studies conducted in EDs have been limited to one hospital centre [13,14], a specific population [15,16], specific therapeutic classes or type of ADEs [17][18][19][20]. Other findings are attributable to retrospective study design [21,22], short periods of observation [2,5,6,[23][24][25], or lack of information on preventability [7,10,26]. Moreover, some literature studies reported preventability assessment referred only to therapeutic classes [4,27,28].…”

Section: Introductionmentioning

confidence: 99%

Characterization and preventability of adverse drug events as cause of emergency department visits: a prospective 1-year observational study

Giudice

Mocciaro

Giardina

et al. 2019

BMC Pharmacol Toxicol

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Background: Adverse drug events (ADEs) are a significant cause of emergency department (ED) visits, with a major impact on healthcare resource utilization. A multicentre observational study, aimed to describe frequency, seriousness and preventability of ADEs reported in four EDs, was performed in Sicily (Italy) over a 1-year period. Methods: Two trained monitors for each ED supported clinicians in identifying ADEs of patients admitted to EDs between June 1st, 2013 and May 31st, 2014 through a systematic interview of patients or their caregivers and with an additional record review. A research team analyzed each case of suspected ADE, to make a causality assessment applying the Naranjo algorithm and a preventability assessment using Schumock and Thornton criteria. Absolute and percentage frequencies with 95% confidence interval (CI) and medians with interquartile ranges (IQR) were estimated. Logistic regression models were used to evaluate independent predictors of serious and certainly preventable ADEs. Results: Out of 16,963 ED visits, 575 (3.4%) were associated to ADEs, of which 15.1% resulted in hospitalization. ADEs were classified as probable in 45.9%, possible in 51.7% and definite in 2.4% of the cases. Moreover, ADEs were considered certainly preventable in 12.3%, probably preventable in 58.4%, and not preventable in 29.2% of the cases. Polytherapy influenced the risk to experience a serious, as well as a certainly preventable ADE. Whilst, older age resulted an independent predictor only of serious events. The most common implicated drug classes were antibiotics (34.4%) and anti-inflammatory drugs (22.6%). ADEs due to psycholeptics and antiepileptics resulted preventable in 62.7 and 54.5% of the cases, respectively. Allergic reactions (64%) were the most frequent cause of ADE-related ED visits, followed by neurological effects (10.2%) that resulted preventable in 1.9 and 37.3% of the cases, respectively. Conclusion: ADEs are a frequent cause of ED visits. The commonly used antibiotics and anti-inflammatory drugs should be carefully managed, as they are widely involved in mild to severe ADEs. Polytherapy is associated with the occurrence of serious, as well as certainly preventable ADEs, while older age only with serious events. A greater sensitivity to drug monitoring programs among health professionals is needed.

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“…Previous studies of ED visits associated with ADRs have been limited to one hospital setting, 14 – 16 a specific population, 17 – 21 specific classes of drug 22 , 23 or types of ADRs, 24 , 25 a retrospective study design, 26 , 27 short periods of observation, 13 , 28 – 32 or did not provide information on preventability. 33 – 35 More extensive studies of ED visits for outpatient ADRs are thus crucial and needed. We have determined the prevalence, preventability, seriousness requiring hospitalization, subsequent 30-day mortality, and economic impact of ADRs presenting to multiple EDs serving a large proportion of the Lombardy region over a 2-year period.…”

Section: Introductionmentioning

confidence: 99%

Seriousness, preventability, and burden impact of reported adverse drug reactions in Lombardy emergency departments: a retrospective 2-year characterization

Perrone¹,

Conti²,

Venegoni³

et al. 2014

CEOR

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ObjectiveThe purpose of this study was to determine the prevalence of adverse drug reactions (ADRs) reported in emergency departments (EDs) and carry out a thorough characterization of these to assess preventability, seriousness that required hospitalization, subsequent 30-day mortality, and economic burden.MethodsThis was a retrospective cohort study of data from an active pharmacovigilance project at 32 EDs in the Lombardy region collected between January 1, 2010 and December 31, 2011. Demographic, clinical, and pharmacological data on patients admitted to EDs were collected by trained and qualified monitors, and deterministic record linkage was performed to estimate hospitalizations. Pharmacoeconomic analyses were based on Diagnosis-Related Group reimbursement.Results8,862 ADRs collected with an overall prevalence rate of 3.5 per 1,000 visits. Of all ADRs, 42% were probably/definitely preventable and 46.4% were serious, 15% required hospitalization, and 1.5% resulted in death. The System Organ Classes most frequently associated with ADRs were: skin and subcutaneous tissue, gastrointestinal, respiratory thoracic and mediastinal, and nervous system disorders. The most common Anatomical Therapeutic Chemical classes involved in admissions were J (anti-infectives and immunomodulating agents), B (blood and blood-forming organs), and N (nervous system). Older age, yellow and red triage, higher number of concomitantly taken drugs, and previous attendance in ED for the same ADR were significantly associated with an increased risk of hospitalization. The total cost associated with ADR management was €5,184,270, with a mean cost per patient of €585. Fifty-eight percent of the economic burden was defined as probably/definitely preventable.ConclusionADRs are a serious health/economic issue in EDs. This assessment provides a thorough estimation of their seriousness, preventability, and burden impact in a large population from a representative European region.

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Assessment of adverse drug event recognition by emergency physicians in a French teaching hospital

Abstract: ADEs are frequent in EDs and are not well recognised by emergency physicians, especially when the drug is involved in a multifactorial pathological condition.

Cited by 35 publications

References 24 publications

Italian Emergency Department Visits and Hospitalizations for Outpatients’ Adverse Drug Events: 12-Year Active Pharmacovigilance Surveillance (The MEREAFaPS Study)

Italian Emergency Department Visits and Hospitalizations for Outpatients’ Adverse Drug Events: 12-Year Active Pharmacovigilance Surveillance (The MEREAFaPS Study)

Characterization and preventability of adverse drug events as cause of emergency department visits: a prospective 1-year observational study

Seriousness, preventability, and burden impact of reported adverse drug reactions in Lombardy emergency departments: a retrospective 2-year characterization

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