ED Visits on the Rise for Adverse Drug Reactions

A new study published by researchers from the Centers for Disease Control and Prevention in Atlanta, Georgia has found a significant increase in the number of emergency department (ED) visits for adverse drug reactions since 2005.

The new findings, which were published online in JAMA earlier this week by Nadine Shehab, PharmD, MPH and colleagues, estimated that each year 4 in every 1000 patients in the ED will be treated for an adverse drug reaction. Of those, more than 25 percent will be hospitalized.  

For the study, researchers evaluated a nationally representative sample of cases from 58 EDs in the United States between 2013 and 2014 and compared those to the number of adverse drug events between 2005 and 2006.

Between the two study periods, ED visits for adverse drug events among elderly patients aged 65 and older increased significantly from 25.6 percent in 2005-2006 to 34.5 percent in 2013-2014.

In 1.8 percent of those ED visits, medications were involved that should always be avoided as treatments for elderly patients. Medications flagged as “potentially inappropriate” for older adults were responsible for 3.4 percent of the ED visits.

A common theme between both study periods was the class of drugs involved in the ED visits. The most common were anticoagulants, antibiotics, diabetes drugs, and opioids. These drugs were the cause of nearly 60 percent of all ED visits for adverse drug events in patients 65 and older.

Antibiotics were the most common cause of adverse drug reaction ED visits among children younger than 6 years old. For youth between the ages of 6 and 19, antipsychotics were the second most common cause after antibiotics.

Despite warnings from the American Psychiatric Association against using antipsychotics as an initial therapy for children and adolescents, the study’s authors say prescriptions for antipsychotics have sharply increased in the last 20 years.

Based on the populations that visit the ED most frequently for adverse drug events, researchers say that medication safety efforts should focus on specific groups like elderly patients and parents of children and adolescents.

Researchers say one major challenge in the effort to reduce the number of ED cases for adverse drug reactions is the lack of collaboration between the ED team and their patients’ primary care team including pharmacy and specialty care providers.

The study intentionally excluded ED visits involving drug withdrawal, therapeutic failure, occupational exposure, intentional overdose, and recreational drug use and still found a 10 percent increase in adverse drug event cases between the two study periods.

To learn more, read the entire study.