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Adverse drug event-related emergency department visits associated with complex chronic conditions

James A Feinstein1, Chris Feudtner2, Allison Kempe3

  • 1Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, Colorado;Division of General Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and james.feinstein@ucdenver.edu.

Pediatrics
|May 21, 2014
PubMed

Insights

Children with complex chronic conditions (CCCs) have higher rates of emergency department visits for adverse drug events (ADEs). While implicated medications differ, CCC status did not increase the risk of hospital admission following an ADE.

Area of Science:

  • Pediatric Emergency Medicine
  • Pharmacovigilance
  • Chronic Disease Management

Background:

  • Outpatient adverse drug events (ADEs) are a significant cause of emergency department (ED) visits and hospitalizations.
  • The impact of ADEs on children with complex chronic conditions (CCCs), who are often on multiple medications, is not well understood.

Purpose of the Study:

  • To characterize ADE-related ED visits in children, focusing on the association with CCC status.
  • To identify medications implicated in ADEs among children.
  • To determine if CCC status influences the risk of admission following an ADE-related ED visit.

Main Methods:

  • Retrospective cohort study utilizing a national sample of pediatric ED visits (ages 0-18).
  • ADEs identified using external cause of injury codes; excluded cases of overdose, wrongful administration, self-harm, or malignancy.
  • Multivariable logistic regression analyzed the association between CCC status and ADE-related ED visits and subsequent admissions, accounting for survey design.

Main Results:

  • 0.5% of 144 million ED visits were linked to ADEs.
  • Children with CCCs had a significantly higher likelihood of ADE-related ED visits (OR 4.76).
  • Implicated medications varied significantly between children with and without CCCs, but CCC status did not significantly alter the odds of admission post-ADE (OR 2.18 for all children).

Conclusions:

  • Children with CCCs are more prone to ADE-related ED visits, with distinct medication profiles.
  • Despite increased ED visits for ADEs, complex chronic condition status did not independently increase the risk for hospital admission.
Abstract

Keywords:
adverse drug eventscomplex chronic conditionsdrug safetyemergency departmentspecial needs

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