Risk factors associated with adverse drug events among older adults in emergency department
Risk factors associated with adverse drug events among older adults in emergency department
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DOI：
10.1016/j.ejim.2013.10.006
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发表时间：
2014-01-01
影响因子：
8
通讯作者：
Yang, Chen-Chang
中科院分区：
文献类型：
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作者：
Chen, Yen-Chia;Fan, Ju-Sing;Yang, Chen-Chang
背景：台湾地区老年人因药物相关伤害而到急诊科（艾德）就诊的情况知之甚少。本研究旨在确定与药物不良事件（ADE）导致艾德visits.Methods相关的风险因素：我们前瞻性地进行了一项病例对照研究的患者65岁及以上的ED。艾德访问2009年3月1日和2010年2月28日之间确定的可疑ADE的研究人员进一步评估使用Naranjo药物不良反应概率量表。对于发生ADE的每例患者，从研究医院的艾德人群中选择一名对照患者并进行时间匹配。不良药物事件的风险和分诊，年龄，性别，血清丙氨酸转氨酶（ALT），血清肌酐，药物的数量，和Charlson合并症指数scores之间的关联进行了分析，使用logistic regression.Results：20,628访问，295 ADE医生记录在老年人。ADE的独立风险因素包括药物数量（3-7种药物的校正比值比[OR] = 4.1; 95%置信区间[CI] 2.4-6.9; 8种或以上药物的校正OR = 6.4; 95% CI 3.7-11.0）和血清肌酐浓度升高（校正OR = 1.5; 95% CI 1.1-2.2）。利尿剂，镇痛剂，心血管药物，抗糖尿病药物和抗凝剂是最常见的药物与ADE导致艾德visits.Conclusions：这项研究表明，预防工作应集中在老年患者肾功能不全和多药谁是使用高风险药物，如抗凝剂，利尿剂，心血管药物，镇痛剂，和抗糖尿病药物。(c)2013年欧洲内科联合会。Elsevier B. V.出版，保留所有权利。
Background: Little is known about the emergency department (ED) visits from drug-related injury among older adults in Taiwan. This study seeks to identify risk factors associated with adverse drug events (ADEs) leading to ED visits.Methods: We prospectively conducted a case-control study of patients 65 years and older presenting to the ED. ED visits between March 1, 2009 and Feb 28, 2010 identified by investigators for suspected ADEs were further assessed by using the Naranjo Adverse Drug Reaction probability scale. For each patient with an ADE, a control was selected and time-matched from the ED population of the study hospital. The association between the risk of adverse drug events and triage, age, gender, serum alanine transaminase (ALT), serum creatinine, number of medications, and Charlson Comorbidity Index scores were analyzed using logistic regression.Results: Of 20,628 visits, 295 ADEs were physician-documented in older adults. Independent risk factors for ADEs included number of medications (adjusted odds ratio [OR] = 4.1; 95% confidence interval [CI] 2.4-6.9 for 3-7 drugs; adjusted OR = 6.4; 95% CI 3.7-11.0 for 8 or more drugs) and increased concentration of serum creatinine (adjusted OR = 1.5; 95% CI 1.1-2.2). Diuretics, analgesics, cardiovascular agents, anti-diabetic agents and anticoagulants were the medications most commonly associated with an ADE leading to ED visits.Conclusions: This study suggests that prevention efforts should be focused on older patients with renal insufficiency and polypharmacy who are using high risk medications such as anticoagulants, diuretics, cardiovascular agents, analgesics, and anti-diabetic agents. (c) 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.