Chen Yen-Chia, Fan Ju-Sing, Chen Min-Hui, Hsu Teh-Fu, Huang Hsien-Hao, Cheng Kuo-Wei, Yen David Hung-Tsang, Huang Chun-I, Chen Liang-Kung, Yang Chen-Chang
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA.
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Eur J Intern Med. 2014 Jan;25(1):49-55. doi: 10.1016/j.ejim.2013.10.006. Epub 2013 Nov 4.
Little is known about the emergency department (ED) visits from drug-related injury among older adults in Taiwan. This study seeks to identify risk factors associated with adverse drug events (ADEs) leading to ED visits.
We prospectively conducted a case-control study of patients 65years and older presenting to the ED. ED visits between March 1, 2009 and Feb 28, 2010 identified by investigators for suspected ADEs were further assessed by using the Naranjo Adverse Drug Reaction probability scale. For each patient with an ADE, a control was selected and time-matched from the ED population of the study hospital. The association between the risk of adverse drug events and triage, age, gender, serum alanine transaminase (ALT), serum creatinine, number of medications, and Charlson Comorbidity Index scores were analyzed using logistic regression.
Of 20,628 visits, 295 ADEs were physician-documented in older adults. Independent risk factors for ADEs included number of medications (adjusted odds ratio [OR]=4.1; 95% confidence interval [CI] 2.4-6.9 for 3-7 drugs; adjusted OR=6.4; 95% CI 3.7-11.0 for 8 or more drugs) and increased concentration of serum creatinine (adjusted OR=1.5; 95% CI 1.1-2.2). Diuretics, analgesics, cardiovascular agents, anti-diabetic agents and anticoagulants were the medications most commonly associated with an ADE leading to ED visits.
This study suggests that prevention efforts should be focused on older patients with renal insufficiency and polypharmacy who are using high risk medications such as anticoagulants, diuretics, cardiovascular agents, analgesics, and anti-diabetic agents.
台湾老年人因药物相关损伤前往急诊科就诊的情况鲜为人知。本研究旨在确定导致急诊科就诊的药物不良事件（ADEs）的相关危险因素。
我们对65岁及以上前往急诊科就诊的患者进行了一项前瞻性病例对照研究。2009年3月1日至2010年2月28日期间，研究人员确定的因疑似ADEs而前往急诊科就诊的患者，使用Naranjo药物不良反应概率量表进行进一步评估。对于每例发生ADEs的患者，从研究医院急诊科人群中选择一名对照并进行时间匹配。使用逻辑回归分析药物不良事件风险与分诊、年龄、性别、血清丙氨酸转氨酶（ALT）、血清肌酐、用药数量和Charlson合并症指数评分之间的关联。
在20628次就诊中，有295例ADEs被医生记录在老年患者中。ADEs的独立危险因素包括用药数量（调整后的优势比[OR]=4.1；3-7种药物时95%置信区间[CI]为2.4-6.9；8种或更多药物时调整后的OR=6.4；95%CI为3.7-11.0）和血清肌酐浓度升高（调整后的OR=1.5；95%CI为1.1-2.2）。利尿剂、镇痛药、心血管药物、抗糖尿病药物和抗凝剂是最常与导致急诊科就诊的ADEs相关的药物。
本研究表明，预防工作应聚焦于肾功能不全和使用多种药物的老年患者，这些患者正在使用抗凝剂、利尿剂、心血管药物、镇痛药和抗糖尿病药物等高风险药物。
