US Emergency Department Visits Attributed to Medication Harms, 2017-2019
US Emergency Department Visits Attributed to Medication Harms, 2017-2019
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DOI：
10.1001/jama.2021.13844
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发表时间：
2021-10-05
影响因子：
120.7
通讯作者：
Pollock, Daniel A.
中科院分区：
文献类型：
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作者：
Budnitz, Daniel S.;Shehab, Nadine;Pollock, Daniel A.
评估急性药物对患者的危害范围应包括治疗性和非治疗性药物的使用。目的分析美国因治疗性和非治疗性药物使用引起的急性伤害的急诊科（ED）就诊特点。设计、设置和参与者基于2017年至2019年参与国家电子伤害监测系统-合作药物不良事件监测项目的美国60个急诊科的患者就诊情况，积极的、具有全国代表性的公共卫生监测。与急诊科就诊有关的药物，根据临床医生的诊断和医疗记录中的支持数据，就诊归因于药物危害（不良事件）。主要结果和测量方法急诊科就诊和随后因药物危害住院的全国加权估计。结果基于96 925例病例（患者平均年龄49岁，55%为女性），估计每1000人中每年有6.1例（95% CI, 4.8-7.5）因药物危害就诊，38.6% （95% CI, 35.2%-41.9%）导致住院。65岁及以上患者因药物伤害而就诊的人群比例高于65岁以下患者（每1000人12.1 vs 5.0 [95% CI, 7.4-16.8 vs 4.1-5.8]）。总体而言，估计69.1% （95% CI, 63.6%-74.7%）的药物危害就诊涉及治疗性用药，但在45岁以下的患者中，估计52.5% （95% CI, 48.1%-56.8%）的药物危害就诊涉及非治疗性用药。巴比妥类药物（6.3%）、苯二氮卓类药物（11.1%）、非阿片类镇痛药（15.7%）和抗组胺药（21.8%）因药物危害而就诊的比例最低。按年龄组划分，65岁及以上患者最常见的药物类型和与药物危害相关的ED就诊意图是治疗性使用抗凝剂（4.5 [95% CI, 2.3-6.7] / 1000人）和糖尿病药物（1.8 [95% CI, 1.3-2.3] / 1000人）；45 - 64岁患者的糖尿病药物治疗使用（0.8 [95% CI, 0.5-1.0] / 1000人）；25至44岁患者非治疗性使用苯二氮卓类药物（1.0 [95% CI, 0.7-1.3] / 1000人）；5岁以下儿童的无监督药物暴露（2.2 [95% CI, 1.8-2.7] / 1000人）和治疗性抗生素使用（1.4 [95% CI, 1.0-1.8] / 1000人）。结论和相关性根据美国60个具有全国代表性的急诊科的数据，2017-2019年因药物危害而就诊的情况很频繁，产品和使用意图因年龄而异。本监测研究描述了美国因治疗性和非治疗性药物使用引起的急性伤害的急诊科就诊特征。2017-2019年，在美国，与急诊室（ED）就诊相关的最常见药物类型和使用意图是什么？在这一具有全国代表性的横断面样本中，包括2017年至2019年期间60名美国急诊科患者，对65岁及以上患者最常见的药物类型和与药物危害（不良事件）相关的急诊科就诊意向的年度估计是抗凝剂（4.5/1000人口）和糖尿病药物（1.8/1000人口）的治疗性使用；45 - 64岁患者抗凝剂（0.6/1000人）和糖尿病药物（0.8/1000人）的治疗使用；25至44岁患者非治疗性使用苯二氮卓类药物（1.0/1000人口）和处方阿片类药物（0.7/1000人口）；5岁以下儿童的无监督药物暴露（2.2/1000）和治疗性抗生素使用（1.4/1000）。这意味着2017-2019年美国急诊室因药物危害的就诊次数频繁，且因药物类型、预期用途和患者年龄而异。
Importance Assessing the scope of acute medication harms to patients should include both therapeutic and nontherapeutic medication use. Objective To describe the characteristics of emergency department (ED) visits for acute harms from both therapeutic and nontherapeutic medication use in the US. Design, Setting, and Participants Active, nationally representative, public health surveillance based on patient visits to 60 EDs in the US participating in the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance Project from 2017 through 2019. Exposures Medications implicated in ED visits, with visits attributed to medication harms (adverse events) based on the clinicians' diagnoses and supporting data documented in the medical record. Main Outcomes and Measures Nationally weighted estimates of ED visits and subsequent hospitalizations for medication harms. Results Based on 96 925 cases (mean patient age, 49 years; 55% female), there were an estimated 6.1 (95% CI, 4.8-7.5) ED visits for medication harms per 1000 population annually and 38.6% (95% CI, 35.2%-41.9%) resulted in hospitalization. Population rates of ED visits for medication harms were higher for patients aged 65 years or older than for those younger than 65 years (12.1 vs 5.0 [95% CI, 7.4-16.8 vs 4.1-5.8] per 1000 population). Overall, an estimated 69.1% (95% CI, 63.6%-74.7%) of ED visits for medication harms involved therapeutic medication use, but among patients younger than 45 years, an estimated 52.5% (95% CI, 48.1%-56.8%) of visits for medication harms involved nontherapeutic use. The proportions of ED visits for medication harms involving therapeutic use were lowest for barbiturates (6.3%), benzodiazepines (11.1%), nonopioid analgesics (15.7%), and antihistamines (21.8%). By age group, the most frequent medication types and intents of use associated with ED visits for medication harms were therapeutic use of anticoagulants (4.5 [95% CI, 2.3-6.7] per 1000 population) and diabetes agents (1.8 [95% CI, 1.3-2.3] per 1000 population) for patients aged 65 years and older; therapeutic use of diabetes agents (0.8 [95% CI, 0.5-1.0] per 1000 population) for patients aged 45 to 64 years; nontherapeutic use of benzodiazepines (1.0 [95% CI, 0.7-1.3] per 1000 population) for patients aged 25 to 44 years; and unsupervised medication exposures (2.2 [95% CI, 1.8-2.7] per 1000 population) and therapeutic use of antibiotics (1.4 [95% CI, 1.0-1.8] per 1000 population) for children younger than 5 years. Conclusions and Relevance According to data from 60 nationally representative US emergency departments, visits attributed to medication harms in 2017-2019 were frequent, with variation in products and intent of use by age.This surveillance study describes the characteristics of emergency department visits for acute harms from both therapeutic and nontherapeutic medication use in the US.Question What were the most frequent medication types and intents of use associated with emergency department (ED) visits for medication harms in the US in 2017-2019? Findings In this cross-sectional nationally representative sample that included 60 US EDs between 2017 and 2019, annual estimates of the most frequent medication types and intents of use associated with ED visits attributed to medication harms (adverse events) were therapeutic use of anticoagulants (4.5/1000 population) and diabetes agents (1.8/1000 population) for patients aged 65 years or older; therapeutic use of anticoagulants (0.6/1000 population) and diabetes agents (0.8/1000 population) for patients aged 45 to 64 years; nontherapeutic use of benzodiazepines (1.0/1000 population) and prescription opioids (0.7/1000 population) for patients aged 25 to 44 years; and unsupervised medication exposures (2.2/1000 population) and therapeutic use of antibiotics (1.4/1000 population) for children younger than 5 years. Meaning Visits to US EDs attributed to medication harms in 2017-2019 were frequent and varied by medication type, intended use, and patient age.