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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.

Author information

1
Faculty of Pharmaceutical Sciences, Department of Emergency Medicine, Faculty of Medicine, and peter.zed@ubc.ca.
2
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;
3
Departments of Emergency Medicine and Department of Emergency Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada;
4
Departments of Emergency Medicine and Performance Excellence, and.
5
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;
6
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;
7
James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio; and.
8
St. Michael's Hospital, Toronto, Ontario, Canada.

Abstract

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.

KEYWORDS:

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

PMID:
25647671
DOI:
10.1542/peds.2014-1827
[Indexed for MEDLINE]
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