Medication-Related Emergency Department Visits in Pediatrics: a Prospective Observational Study
BACKGROUND AND OBJECTIVE: There are few data on the rate and characterization of medication-related visits (MRVs) to the emergency department (ED) in pediatric patients. We sought to evaluate the frequency, severity, preventability, and classification of MRVs to the ED in pediatric patients.
METHODS: We performed a prospective observational study of pediatric patients presenting to the ED over a 12-month period. A medication-related ED visit was identified by using pharmacist assessment, emergency physician assessment, and an independent adjudication committee.
RESULTS: In this study, 2028 patients were enrolled (mean age, 6.1 ± 5.0 years; girls, 47.4%). An MRV was found in 163 patients (8.0%; 95% confidence interval [CI]: 7.0%–9.3%) of which 106 (65.0%; 95% CI: 57.2%–72.3%) were deemed preventable. Severity was classified as mild in 14 cases (8.6%; 95% CI: 4.8%–14.0%), moderate in 140 cases (85.9%; 95% CI: 79.6%–90.8%), and severe in 9 cases (5.5%; 95% CI: 2.6%–10.2%). The most common events were related to adverse drug reactions 26.4% (95% CI: 19.8%–33.8%), subtherapeutic dosage 19.0% (95% CI: 13.3%–25.9%), and nonadherence 17.2% (95% CI: 11.7%–23.9%). The probability of hospital admission was significantly higher among patients with an MRV compared with those without an MRV (odds ratio, 6.5; 95% CI: 4.3–9.6) and, if admitted, the median (interquartile range) length of stay was longer (3.0 [5.0] days vs 1.5 [2.5] days, P = .02).
CONCLUSIONS: A medication-related cause was found in ∼1 of every 12 ED visits by pediatric patients, of which two-thirds were deemed preventable. Pediatric patients who present to the ED with an MRV are more likely to be admitted to hospital and when admitted have a longer length of stay.
- adverse drug events
- adverse events
- adverse drug reaction
- emergency department
- patient safety
- Accepted December 9, 2014.
- Copyright © 2015 by the American Academy of Pediatrics