US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014.
US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014.
复制标题
美国急诊科访问门诊不良药物事件，2013 - 2014年。
DOI：
10.1001/jama.2016.16201
复制
发表时间：
2016-11-22
期刊：
影响因子：
--
通讯作者：
Budnitz DS
中科院分区：
文献类型：
--
作者：
Shehab N;Lovegrove MC;Geller AI;Rose KO;Weidle NJ;Budnitz DS
2010 年《患者保护和平价医疗法案》在国家患者安全工作中引起了对药物不良事件的关注。描述药物不良事件的更新的、详细的、具有全国代表性的数据可以帮助集中这些努力。描述 2013-2014 年美国因药物不良事件急诊科 (ED) 就诊的特征，并描述 2005-2006 年以来因药物不良事件急诊科就诊的变化。在美国 58 个急诊室开展积极的、具有全国代表性的公共卫生监测，并参与国家电子伤害监测系统——合作性药物不良事件监测项目。急诊室就诊涉及的药物。对急诊就诊和随后因药物不良事件住院的全国加权估计。根据 42 585 例病例的数据，2013 年和 2014 年，每年每 1000 人中估计有 4.0 人（95% CI，3.1-5.0）人因药物不良事件就诊，其中 27.3%（95% CI，22.2%-32.4%）因药物不良事件而入院就诊。 2013-2014 年，估计 34.5%（95% CI，30.3%-38.8%）因药物不良事件就诊的患者为 65 岁或以上的成年人，而 2005-2006 年估计为 25.6%（95% CI，21.1%-30.0%）；老年人的住院率最高（43.6%；95% CI，36.6%-50.5%）。估计 46.9%（95% CI，44.2%-49.7%）因药物不良事件而就诊的急诊室就诊涉及抗凝剂、抗生素和糖尿病药物，其中包括临床上显着的不良事件，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系统影响的低血糖（糖尿病药物）。自2005-2006年以来，因抗凝剂和糖尿病药物不良事件而就诊的比例有所增加，而因抗生素不良事件而就诊的比例有所下降。在 5 岁或以下儿童中，抗生素是最常见的相关药物类别（56.4%；95% CI，51.8-61.0%）。在 6 至 19 岁的儿童和青少年中，抗生素也是因药物不良事件而就诊的最常见药物类别（31.8%；95% CI，28.7%-34.9%），其次是抗精神病药物（4.5%；95% CI，3.3-5.6%）。在老年人（年龄≥65岁）中，估计有59.9%（95% CI，56.8%-62.9%）因药物不良事件而就诊的急诊室就诊涉及3类药物（抗凝剂、糖尿病药物和阿片类镇痛药）； 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）是 15 种最常见的相关药物。根据 Beers 标准，老年人应避免使用的药物与 1.8%（95% CI，1.5%-2.1%）的急诊就诊的药物不良事件有关。 2013 年和 2014 年，美国因药物不良事件而到急诊室就诊的比例估计为每 1000 人中有 4 人就诊。最常见的相关药物类别是抗凝剂、抗生素、糖尿病药物和阿片类镇痛药。
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. 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.
登录
查看更多内容
影响因子：
16.2
作者：
Munshi MN;Florez H;Huang ES;Kalyani RR;Mupanomunda M;Pandya N;Swift CS;Taveira TH;Haas LB
通讯作者：
Haas LB
DOI：
10.1001/jama.2016.0299
发表时间：
2016-03-08
期刊：
JAMA
影响因子：
--
作者：
Lipska KJ;Krumholz H;Soones T;Lee SJ
通讯作者：
Lee SJ
影响因子：
6.3
作者：
Jirón M;Pate V;Hanson LC;Lund JL;Jonsson Funk M;Stürmer T
通讯作者：
Stürmer T
影响因子：
6.3
作者：
Radcliff, Sue;Yue, Jirong;Beers, Mark H.
通讯作者：
Beers, Mark H.
DOI：
10.1016/j.amjmed.2015.05.044
发表时间：
2015-12
期刊：
The American journal of medicine
影响因子：
--
作者：
Barnes GD;Lucas E;Alexander GC;Goldberger ZD
通讯作者：
Goldberger ZD