Adverse Drug Event Nonrecognition in Emergency Departments
Adverse Drug Event Nonrecognition in Emergency Departments
Of 472 patients who met inclusion criteria, 7 (1.5%) were excluded because the ED medical investigations were insufficient to identify an ADE with certainty (Figure 1). The baseline characteristics of the 465 patients considered for analysis are presented in Table 1 .
(Enlarge Image)
Figure 1.
Patient flow. ADE = adverse drug event; ED = emergency department.
We determined that 90 patients visited our medical ED with an ADE (19.4%; 95% confidence interval [CI] 15.9%–23.2%). Emergency physicians attributed 36 of these cases (40.0%; 95% CI 29.8%–50.9%) to a medication-related problem ( Table 2 ). No ADE was identified in all three readmissions.
ADE diagnoses were most frequently bleeding (16.7%), secondary infectious disease (12.2%), water–electrolyte imbalance (11.1%), acute renal failure (11.1%), constipation (7.8%), and consciousness disorders (7.8%). Of the identified ADEs, 51 (56.7%) led to hospitalization (C–E gravity categories), and 6 of these were deemed to be serious and 2 were fatal (2 cases of intracerebral bleeding when on antithrombotic therapy, leading to 1 death in ED and 1 death after ED discharge to a medical department). Drug categories most commonly causing ADEs were antithrombotic agents (13.0%), agents acting on the renin–angiotensin system (12.3%), opioids (10.9%), diuretics (global: 9.4%; furosemide: 8.0%), and glucocorticoids (7.2%).
On univariate analysis, ADE nonrecognition was significantly associated with increasing age, increasing number of daily medications, the nonrelation between the ADE and the patient's chief complaint, a possible ADE causality category, and a hospitalization ADE severity category ( Table 2 ). An ADE diagnosis of bleeding was more frequent in patients with an attributed ADE than in patients with an unattributed ADE (27.8 vs, 9.3%, respectively, p = 0.021).
All included patients were considered for multivariate analysis. After adjustment for confounders, ADE nonrecognition was significantly associated with the nonrelation between the ADE and the patient's chief complaint, a daily prescription of four drugs or more, and a hospitalization ADE severity category ( Table 3 ). A good fit of our model was not rejected (p = 0.80).
Results
Of 472 patients who met inclusion criteria, 7 (1.5%) were excluded because the ED medical investigations were insufficient to identify an ADE with certainty (Figure 1). The baseline characteristics of the 465 patients considered for analysis are presented in Table 1 .
(Enlarge Image)
Figure 1.
Patient flow. ADE = adverse drug event; ED = emergency department.
We determined that 90 patients visited our medical ED with an ADE (19.4%; 95% confidence interval [CI] 15.9%–23.2%). Emergency physicians attributed 36 of these cases (40.0%; 95% CI 29.8%–50.9%) to a medication-related problem ( Table 2 ). No ADE was identified in all three readmissions.
ADE diagnoses were most frequently bleeding (16.7%), secondary infectious disease (12.2%), water–electrolyte imbalance (11.1%), acute renal failure (11.1%), constipation (7.8%), and consciousness disorders (7.8%). Of the identified ADEs, 51 (56.7%) led to hospitalization (C–E gravity categories), and 6 of these were deemed to be serious and 2 were fatal (2 cases of intracerebral bleeding when on antithrombotic therapy, leading to 1 death in ED and 1 death after ED discharge to a medical department). Drug categories most commonly causing ADEs were antithrombotic agents (13.0%), agents acting on the renin–angiotensin system (12.3%), opioids (10.9%), diuretics (global: 9.4%; furosemide: 8.0%), and glucocorticoids (7.2%).
On univariate analysis, ADE nonrecognition was significantly associated with increasing age, increasing number of daily medications, the nonrelation between the ADE and the patient's chief complaint, a possible ADE causality category, and a hospitalization ADE severity category ( Table 2 ). An ADE diagnosis of bleeding was more frequent in patients with an attributed ADE than in patients with an unattributed ADE (27.8 vs, 9.3%, respectively, p = 0.021).
All included patients were considered for multivariate analysis. After adjustment for confounders, ADE nonrecognition was significantly associated with the nonrelation between the ADE and the patient's chief complaint, a daily prescription of four drugs or more, and a hospitalization ADE severity category ( Table 3 ). A good fit of our model was not rejected (p = 0.80).