Nixdorff Neil, Hustey Fredric M, Brady Anna K, Vaji Kristina, Leonard Mandy, Messinger-Rapport Barbara J
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Am J Emerg Med. 2008 Jul;26(6):697-700. doi: 10.1016/j.ajem.2007.12.007.
The objective of this study was to examine the prevalence of potentially inappropriate medications (PIMs) and potential adverse drug effects (ADEs) in older adults presenting to the emergency department (ED). This was a prospective observational study of a convenience sample of adults 65 years and older presenting to the ED at an urban, tertiary care hospital. Potentially inappropriate medications were defined according to 2003 Beers criteria. Potential ADEs were defined as either (1) a potential drug-drug interaction, (2) alternative medication likely to cause toxicity or drug interactions, or (3) toxic doses of vitamins or minerals. Of 174 eligible patients, 124 were enrolled. The mean number of medications used per patient was 8.6 (range, 0-20). Thirty six patients (29%, 95% confidence interval, 27%-37%) presented to the ED with at least one PIM. Eight PIMs were prescribed in the ED, representing 16% of all prescriptions in the ED. Potential ADEs meeting the defined criteria were found in 26.6% of patients. A subanalysis of a random sample of charts revealed significant discordance between medication lists obtained by the research assistants and that of the health care providers. Older ED patients are at high risk for use of potentially inappropriate medications and ADEs. This problem may be magnified by inaccurate medication lists obtained by ED providers. A larger multicenter study may help to better define the scope of this problem.
本研究的目的是调查前往急诊科（ED）就诊的老年人中潜在不适当用药（PIMs）和潜在药物不良反应（ADEs）的发生率。这是一项对一家城市三级护理医院急诊科65岁及以上成年便利样本进行的前瞻性观察研究。潜在不适当用药根据2003年《Beers标准》进行定义。潜在药物不良反应被定义为以下情况之一：（1）潜在的药物相互作用；（2）可能导致毒性或药物相互作用的替代药物；（3）维生素或矿物质的中毒剂量。在174名符合条件的患者中，124名被纳入研究。每位患者使用的药物平均数量为8.6种（范围为0 - 20种）。36名患者（29%，95%置信区间为27% - 37%）前往急诊科时至少有一种潜在不适当用药。急诊科开出了8种潜在不适当用药，占急诊科所有处方的16%。在26.6%的患者中发现了符合定义标准的潜在药物不良反应。对随机抽取的病历样本进行的亚分析显示，研究助理获取的用药清单与医疗服务提供者的用药清单之间存在显著差异。急诊科老年患者使用潜在不适当用药和发生药物不良反应的风险很高。急诊科提供者获取的不准确用药清单可能会加剧这一问题。一项更大规模的多中心研究可能有助于更好地界定这一问题的范围。
