Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures, 2004–2013

Abstract

Background Following reports of increasing emergency department (ED) visits for unsupervised pediatric medication exposures in the 2000s, renewed efforts to improve safety packaging and education were initiated. National data on current trends and implicated medications can help further target interventions. Methods We used nationally-representative data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project (2004–2013) to assess trends in ED visits for unsupervised medication exposures in children aged <6 years. For 2010–2013, we identified the dosage form and prescription status of implicated medications. Results Based on 13,268 cases, there were an estimated 640,161 ED visits (95% confidence interval: 512,885–767,436) for unsupervised medication exposures from 2004–2013. From 2004–2010, the number of ED visits for unsupervised exposures increased by an average of 5.7% annually, peaking at 75,842. After 2010, this trend reversed and ED visits decreased by an average of 6.7% annually to 59,092 estimated visits in 2013. From 2010–2013, 91.0% of ED visits for unsupervised exposures involved 1 medication, most commonly an oral prescription solid (45.9%), oral over-the-counter (OTC) solid (22.3%), or oral OTC liquid (12.4%); 9.0% of visits involved >1 medication. Over 260 different prescription solids were implicated; opioids (13.8%) and benzodiazepines (12.7%) were the most commonly implicated classes. Four medications were implicated in 91.2% of OTC liquid exposure visits: acetaminophen (32.9%), cough and cold remedies (27.5%), ibuprofen (15.7%), and diphenhydramine (15.6%). Conclusions Targeting prevention efforts based on harm frequency and intervention feasibility can lead to continued reductions in ED visits for pediatric medication exposures.

Nonsteroidal Anti-Inflammatory Drug Toxicity in Children

“…19 Between 2010 and 2013, ibuprofen accounted for 16% of US emergency department visits for unsupervised over-the-counter liquid medication exposures in young children. 20 In 1 Australian province, approximately 4% of calls to the poison center and 4.5% of emergency visits for ingestions were for NSAIDs. 21 In Spain, 38 of 2157 cases of childhood poisoning were from ibuprofen.…”

Nonsteroidal Anti-Inflammatory Drug Toxicity in Children

“…14 However, the American Academy of Pediatrics notes the potential risk of inaccurate dosing and overdosing from this practice. 20 In 1 Australian province, approximately 4% of calls to the poison center and 4.5% of emergency visits for ingestions were for NSAIDs. 16 The widespread use of NSAIDs increases the risk of acute NSAID exposure, ingestions, and toxicities in children.…”

Consumer Healthcare Products Association response to Major et al., “Trends in rates of acetaminophen‐related adverse events in the United States”, Pharmacoepidemiology & Drug Safety, May 2016, 25: 590–8

“…Although continued research‐based and targeted interventions are necessary to further reduce acetaminophen exposures, the Major et al . study, analyses from the RMPDC and recent results from the CDC and Safe Kids Worldwide showing a decline in unsupervised pediatric exposures, provide clear evidence that programs designed to further increase safe acetaminophen use and decrease unsupervised ingestions among young children (a primary driver of the acetaminophen exposures seen in children aged 5 and under, and included in the Major et al . analysis) are having a measurable impact.…”