Shehab Nadine, Lovegrove Maribeth C, Geller Andrew I, Rose Kathleen O, Weidle Nina J, Budnitz Daniel S
Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia.
Northrup Grumman Corporation, Atlanta, Georgia.
JAMA. 2016 Nov 22;316(20):2115-2125. doi: 10.1001/jama.2016.16201.
The Patient Protection and Affordable Care Act of 2010 brought attention to adverse drug events in national patient safety efforts. Updated, detailed, nationally representative data describing adverse drug events can help focus these efforts.
To describe the characteristics of emergency department (ED) visits for adverse drug events in the United States in 2013-2014 and describe changes in ED visits for adverse drug events since 2005-2006.
DESIGN, SETTING, AND PARTICIPANTS: Active, nationally representative, public health surveillance in 58 EDs located in the United States and participating in the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project.
Drugs implicated in ED visits.
National weighted estimates of ED visits and subsequent hospitalizations for adverse drug events.
Based on data from 42 585 cases, an estimated 4.0 (95% CI, 3.1-5.0) ED visits for adverse drug events occurred per 1000 individuals annually in 2013 and 2014 and 27.3% (95% CI, 22.2%-32.4%) of ED visits for adverse drug events resulted in hospitalization. An estimated 34.5% (95% CI, 30.3%-38.8%) of ED visits for adverse drug events occurred among adults aged 65 years or older in 2013-2014 compared with an estimated 25.6% (95% CI, 21.1%-30.0%) in 2005-2006; older adults experienced the highest hospitalization rates (43.6%; 95% CI, 36.6%-50.5%). Anticoagulants, antibiotics, and diabetes agents were implicated in an estimated 46.9% (95% CI, 44.2%-49.7%) of ED visits for adverse drug events, which included clinically significant adverse events, such as hemorrhage (anticoagulants), moderate to severe allergic reactions (antibiotics), and hypoglycemia with moderate to severe neurological effects (diabetes agents). Since 2005-2006, the proportions of ED visits for adverse drug events from anticoagulants and diabetes agents have increased, whereas the proportion from antibiotics has decreased. Among children aged 5 years or younger, antibiotics were the most common drug class implicated (56.4%; 95% CI, 51.8%-61.0%). Among children and adolescents aged 6 to 19 years, antibiotics also were the most common drug class implicated (31.8%; 95% CI, 28.7%-34.9%) in ED visits for adverse drug events, followed by antipsychotics (4.5%; 95% CI, 3.3%-5.6%). Among older adults (aged ≥65 years), 3 drug classes (anticoagulants, diabetes agents, and opioid analgesics) were implicated in an estimated 59.9% (95% CI, 56.8%-62.9%) of ED visits for adverse drug events; 4 anticoagulants (warfarin, rivaroxaban, dabigatran, and enoxaparin) and 5 diabetes agents (insulin and 4 oral agents) were among the 15 most common drugs implicated. Medications to always avoid in older adults according to Beers criteria were implicated in 1.8% (95% CI, 1.5%-2.1%) of ED visits for adverse drug events.
The prevalence of emergency department visits for adverse drug events in the United States was estimated to be 4 per 1000 individuals in 2013 and 2014. The most common drug classes implicated were anticoagulants, antibiotics, diabetes agents, and opioid analgesics.
2010年的《患者保护与平价医疗法案》使全国患者安全工作中对药物不良事件的关注有所增加。更新的、详细的、具有全国代表性的数据描述药物不良事件有助于集中这些工作的重点。
描述2013 - 2014年美国因药物不良事件导致的急诊就诊特征，并描述自2005 - 2006年以来因药物不良事件导致的急诊就诊变化情况。
设计、地点和参与者：在美国58家急诊室进行的具有全国代表性的主动公共卫生监测，这些急诊室参与了国家电子伤害监测系统 - 合作药物不良事件监测项目。
与急诊就诊相关的药物。
因药物不良事件导致的急诊就诊及随后住院的全国加权估计数。
基于42585例病例的数据，2013年和2014年估计每1000人每年有4.0次（95%置信区间，3.1 - 5.0）因药物不良事件导致的急诊就诊，且27.3%（95%置信区间，22.2% - 32.4%）因药物不良事件导致的急诊就诊会导致住院。2013 - 2014年，估计65岁及以上成年人中34.5%（95%置信区间，30.3% - 38.8%）的急诊就诊是因药物不良事件，而2005 - 2006年这一比例估计为25.6%（95%置信区间，21.1% - 30.0%）；老年人的住院率最高（43.6%；95%置信区间，36.6% - 50.5%）。抗凝剂、抗生素和糖尿病药物估计涉及46.9%（95%置信区间，44.2% - 49.7%）的因药物不良事件导致的急诊就诊，其中包括具有临床意义的不良事件，如出血（抗凝剂）、中度至重度过敏反应（抗生素）以及伴有中度至重度神经效应的低血糖（糖尿病药物）。自2005 - 2006年以来，因抗凝剂和糖尿病药物导致的药物不良事件急诊就诊比例有所增加，而因抗生素导致的比例有所下降。在5岁及以下儿童中，抗生素是最常见的涉事药物类别（56.4%；95%置信区间，51.8% - 61.0%）。在6至19岁儿童和青少年中，抗生素也是因药物不良事件导致的急诊就诊中最常见的涉事药物类别（31.8%；95%置信区间，28.7% - 34.9%），其次是抗精神病药物（4.5%；95%置信区间：3.3% - 5.6%）。在老年人（年龄≥65岁）中，3类药物（抗凝剂、糖尿病药物和阿片类镇痛药）估计涉及59.9%（95%置信区间，56.8% - 62.9%）的因药物不良事件导致的急诊就诊；15种最常见的涉事药物中有4种抗凝剂（华法林、利伐沙班、达比加群和依诺肝素）和5种糖尿病药物（胰岛素和4种口服药物）。根据Beers标准应在老年人中始终避免使用的药物涉及1.8%（95%置信区间，1.5% - 2.1%）的因药物不良事件导致的急诊就诊。
2013年和2014年美国因药物不良事件导致的急诊就诊患病率估计为每1000人中有4次。最常见的涉事药物类别是抗凝剂、抗生素、糖尿病药物和阿片类镇痛药。
