Adverse drug reactions leading children to the emergency department
Nicolina Silvana Romano Lieber1, Eliane Ribeiro
1Departamento de Prática de Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo. nicolina@usp.br
Insights
Adverse drug reactions (ADRs) in children are uncommon in emergency care, with antibiotics being the most frequent cause. Further research is needed to develop prevention strategies for these reactions.
Area of Science:
- Pediatrics
- Pharmacovigilance
- Public Health
Background:
- Adverse drug reactions (ADRs) are a significant concern in pediatric healthcare.
- Understanding the incidence and characteristics of ADRs leading to emergency care is crucial for patient safety.
Purpose of the Study:
- To determine the incidence of adverse drug reactions (ADRs) requiring pediatric emergency care.
- To identify the drugs and clinical manifestations associated with these ADRs.
Main Methods:
- Retrospective study analyzing medical charts (MC) of pediatric emergency department patients.
- Data selection based on International Classification of Diseases (ICD) codes indicative of ADRs.
- Analysis of 83 confirmed ADR cases out of 23,286 initial records.
Main Results:
- An incidence of 0.36% for ADRs leading to emergency care was observed.
- Systemic antibiotics were the most common cause (53.0%), followed by vaccines (9.6%) and analgesics (7.2%).
- Dermatological (54.2%) and gastrointestinal (22.9%) manifestations were most frequent; most ADRs were mild or moderate.
Conclusions:
- The incidence of ADRs in this study was lower than reported in other literature, potentially due to the retrospective methodology.
- ADRs in children share similar characteristics globally, highlighting the need for improved antibiotic stewardship and ADR diagnosis.
- Hospital emergency research provides valuable insights into ADRs occurring outside hospital settings, aiding in the identification of severe cases and informing prevention strategies.
Abstract:
The aim of the study was to determine the incidence of adverse drug reactions (ADR) that led children to hospital emergency care in a university hospital in São Paulo, SP. Medical charts (MC) of patients seen at the pediatric emergency department were selected according to International Classification of Diseases (ICD) codes consistent with ADR. Of 23,286 cases studied, 2,409 records were selected. An ADR was observed in 83 (0.36%) MC. Most ADR occurred in children aged 1-5 years with a slight predominance in males (51.8%). The drugs most commonly involved were antibiotics for systemic use (53.0%), vaccines (9.6%) and analgesics (7.2%). Most ADR were dermatological (54.2%) or gastrointestinal (22.9%) manifestations. Two ADR were considered severe (2.4%) while 61.4% were mild and 36.1% were moderate. The incidence was lower than in the literature, probably because it is a retrospective study that used the ICD for selecting the data assessed. The characteristics of ADR are similar to those found in other countries. Interventions are needed to improve the diagnosis and the use of antibiotics, as they were the drugs most involved in the ADR observed. Research in hospital emergency is important to acknowledge ADR that occur outside the hospital setting and may help to identify the most severe ones. Despite limitations, the method requires few resources and materials, and is a good alternative to initial diagnosis. The present study should be followed by studies with higher sensitivity to detect these reactions in order to propose prevention measures.
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Pharmacovigilance
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...


