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Medication-related emergency department visits in pediatrics: a prospective observational study
Peter J Zed1, Karen J L Black2, Eleanor A Fitzpatrick3
1Faculty of Pharmaceutical Sciences, Department of Emergency Medicine, Faculty of Medicine, and peter.zed@ubc.ca.
Insights
Medication-related visits (MRVs) account for 8% of pediatric emergency department (ED) visits, with two-thirds preventable. These visits increase hospital admission rates and length of stay for children.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacovigilance
- Public Health
Background:
- Limited data exist on the frequency and characteristics of medication-related visits (MRVs) to emergency departments (EDs) in pediatric populations.
- Understanding these events is crucial for improving medication safety in children.
Purpose of the Study:
- To evaluate the frequency, severity, preventability, and classification of MRVs in pediatric patients presenting to the ED.
- To identify common causes of MRVs in children.
Main Methods:
- A prospective observational study was conducted over 12 months.
- Pediatric patients presenting to the ED were assessed for MRVs using pharmacist and emergency physician evaluations, with independent adjudication.
Main Results:
- Of 2028 enrolled patients, 8.0% had an MRV, with 65.0% deemed preventable.
- The most common causes were adverse drug reactions (26.4%), subtherapeutic dosage (19.0%), and nonadherence (17.2%).
- MRVs were associated with a significantly higher likelihood of hospital admission (OR, 6.5) and longer hospital stays.
Conclusions:
- Medication-related causes account for approximately 1 in 12 pediatric ED visits, with a majority being preventable.
- Pediatric patients with MRVs are more likely to be admitted and experience extended hospital stays.
Background And Objective:
There are few data on the rate and characterization of medication-related visits (MRVs) to the emergency department (ED) in pediatric patients. We sought to evaluate the frequency, severity, preventability, and classification of MRVs to the ED in pediatric patients.
Methods:
We performed a prospective observational study of pediatric patients presenting to the ED over a 12-month period. A medication-related ED visit was identified by using pharmacist assessment, emergency physician assessment, and an independent adjudication committee.
Results:
In this study, 2028 patients were enrolled (mean age, 6.1 ± 5.0 years; girls, 47.4%). An MRV was found in 163 patients (8.0%; 95% confidence interval [CI]: 7.0%-9.3%) of which 106 (65.0%; 95% CI: 57.2%-72.3%) were deemed preventable. Severity was classified as mild in 14 cases (8.6%; 95% CI: 4.8%-14.0%), moderate in 140 cases (85.9%; 95% CI: 79.6%-90.8%), and severe in 9 cases (5.5%; 95% CI: 2.6%-10.2%). The most common events were related to adverse drug reactions 26.4% (95% CI: 19.8%-33.8%), subtherapeutic dosage 19.0% (95% CI: 13.3%-25.9%), and nonadherence 17.2% (95% CI: 11.7%-23.9%). The probability of hospital admission was significantly higher among patients with an MRV compared with those without an MRV (odds ratio, 6.5; 95% CI: 4.3-9.6) and, if admitted, the median (interquartile range) length of stay was longer (3.0 [5.0] days vs 1.5 [2.5] days, P = .02).
Conclusions:
A medication-related cause was found in ∼1 of every 12 ED visits by pediatric patients, of which two-thirds were deemed preventable. Pediatric patients who present to the ED with an MRV are more likely to be admitted to hospital and when admitted have a longer length of stay.
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