Drug-adverse related events in emergency department : Epidemiological,clinical profile and prognosis

Adverse-drug events (ADe) are frequent in emergency medicine and remain misdiagnosed depending on the clinical polymorphism and the underlying comorbidities. Older patients with multiple comorbidities and polypharmacy are more frequently affected and makes poor prognosis.

The aim of this study was to evaluate the epidemiology of ADe in the emergency department (ED) visits and to identify the prognostic value mortality within 30 days.

Prospective, monocentric study. Patients were included if they met criteria of aADe. We evaluated severity and mortality at 30 days. Moreover, misuse and preventabilty were studied.

We included 159 cases within 113,272 ED visits. Mean age = 64 ± 19 years, sex ratio =0.6.The average number of drugs was 4.5 ± 3. Polymedication was found in 54%. In 10 cases, the prescription contained twice the same molecule. A double ADe was found in 11 patients. We identified 55 cases of misuse, 94% of them were due to physician. An interaction was found in 23 patients. Improper prescription with age, renal function or presence of contra-indications was found in 46 patients. In 41% cases, ADR events were preventable. An ADR event was considered severe in 44% of cases and 30-Days mortality's rate was 9.4%. Drugs n (%): Anticoagulants 53(34,6); Antihypertensive 29(19); Antiarrhythmic 15(10). Multivariate analysis of mortality at day 30: Misuse and polyapthology were independent predictors; Respective Odds ratios: (OR: 2.6; 95% CI [1.25-5.38]; p=0,001) and (OR 2.31; 95% CI [1,16 - 4,61]; p=0,017).

Drug-related ED visits are common in elderly. ADe is severe in 44% cases and preventable in 41%. Mortality rate was 9,4%. Misuse, polypharmacy and comorbidities were independent predictors of severity and mortality.