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Pediatrics. 2015 Mar;135(3):435-43. doi: 10.1542/peds.2014-1827. Epub 2015 Feb 2.

Medication-related emergency department visits in pediatrics: a prospective observational study.

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Faculty of Pharmaceutical Sciences, Department of Emergency Medicine, Faculty of Medicine, and
Division of Emergency Medicine, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada; University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada;
Departments of Emergency Medicine and Department of Emergency Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada;
Departments of Emergency Medicine and Performance Excellence, and.
Departments of Emergency Medicine and IWK Regional Poison Control Centre, Halifax, Nova Scotia, Canada; Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Capital Health, Halifax, Nova Scotia, Canada;
Departments of Emergency Medicine and Department of Emergency Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada; School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada;
James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio; and.
St. Michael's Hospital, Toronto, Ontario, Canada.



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.


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.


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).


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 drug reaction; adverse events; emergency department; hospitalization; patient safety; pediatrics

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