Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Italian Journal of Pediatrics
Published in: Italian Journal of Pediatrics 1/2017

Open Access 01-12-2017 | Research

Medication-related visits in a pediatric emergency department: an 8-years retrospective analysis

Authors: Cristiano Rosafio, Serena Paioli, Cinzia Del Giovane, Valentina Cenciarelli, Nilla Viani, Paolo Bertolani, Lorenzo Iughetti

Published in: Italian Journal of Pediatrics | Issue 1/2017

Login to get access

Abstract

Background

There are limited data on the characterization of medication-related visits (MRVs) to the emergency department (ED) in pediatric patients in Italy. We have estimated the frequency, severity, and classification of MRVs to the ED in pediatric patients.

Methods

We retrospectively analyzed data for children seeking medical evaluation for a MRV over an 8 years period. A medication-related ED visit was identified by using a random pharmacist assessment, emergency physician assessment, and in case of conflicting events, by a third investigators random assessment.

Results

In this study, regarding a single tertiary center in Italy, on a total of 147,643 patients from 0 to 14 years old, 497 medication-related visits were found, 54% of which occurred in children from 0 to 2 years of age. Severity was classified as mild in 21.6% of cases, moderate in 67.2% of cases, and severe in 11.2% of cases. The most common events were related to drug use without indication (51%), adverse drug reactions (30.3%), supratherapeutic dosage (13.2%) and improper drug selection (4.5%).
The medication classes most frequently implicated in an ADE were anti-infective drugs for systemic use (28.9%), central nervous system agents (22.3%) and respiratory system drugs (10.8%).
The most common symptom manifestations were dermatologic conditions (46.1%), general disorder and administration site conditions (29.7%) and gastrointestinal symptoms (16.0%).

Conclusions

To our knowledge, this is the first study in Italy evaluating the epidemiologic characteristics of MRVs confirming a significant cause of healthcare contact resulting in ED visits and hospital admissions with associated resource utilization. Our results suggests further future prospective, large-sample sized, and multicenter research is necessary to better understand the impact of MRVs and to develop strategies to provide care plans and monitor patients to prevent medication-related visits.

Trial registration

Not applicable.
Literature
1.
Nebeker JR, Barach P, Samore MH. Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting. Ann Intern Med. 2004;140(10):795–801.CrossRefPubMed
2.
Gurwitz D, McLeod HL. Primum non nocere: adverse drug events must be taken seriously. Pharmacogenomics. 2007;8(4):311–4.CrossRefPubMed
3.
Johnson JA, Bootman JL. Drug-related morbidity and mortality. A cost-of-illness model. Arch Intern Med. 1995;155(18):1949–56.CrossRefPubMed
4.
Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA. 1997;277(4):307–11.CrossRefPubMed
5.
Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc. 2001;41(2):192–9.CrossRef
6.
Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004;170(11):1678–86.CrossRefPubMedPubMedCentral
7.
Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995;274(1):29–34.CrossRefPubMed
8.
Nelson KM, Talbert RL. Drug-related hospital admissions. Pharmacotherapy. 1996;16(4):701–7.PubMed
9.
Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1997;277(4):301–6.CrossRefPubMed
10.
Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279(15):1200–5.CrossRefPubMed
11.
Lagnaoui R, Moore N, Fach J, Longy-Boursier M, Begaud B. Adverse drug reactions in a department of systemic diseases-oriented internal medicine: prevalence, incidence, direct costs and avoidability. Eur J Clin Pharmacol. 2000;56(2):181–6.CrossRefPubMed
12.
McDonnell PJ, Jacobs MR. Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother. 2002;36(9):1331–6.CrossRefPubMed
13.
Peyriere H, Cassan S, Floutard E, Riviere S, Blayac JP, Hillaire-Buys D, et al. Adverse drug events associated with hospital admission. Ann Pharmacother. 2003;37(1):5–11.CrossRefPubMed
14.
Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004;329(7456):15–9.CrossRefPubMedPubMedCentral
15.
Samoy LJ, Zed PJ, Wilbur K, Balen RM, Abu-Laban RB, Roberts M. Drug-related hospitalizations in a tertiary care internal medicine service of a Canadian hospital: a prospective study. Pharmacotherapy. 2006;26(11):1578–86.CrossRefPubMed
16.
Kaiser RM, Schmader KE, Pieper CF, Lindblad CI, Ruby CM, Hanlon JT. Therapeutic failure-related hospitalisations in the frail elderly. Drugs Aging. 2006;23(7):579–86.CrossRefPubMed
17.
Sikdar KC, Alaghehbandan R, MacDonald D, Barrett B, Collins KD, Donnan J, et al. Adverse drug events in adult patients leading to emergency department visits. Ann Pharmacother. 2010;44(4):641–9.CrossRefPubMed
18.
Zed PJ, Abu-Laban RB, Balen RM, Loewen PS, Hohl CM, Brubacher JR, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ. 2008;178(12):1563–9.CrossRefPubMedPubMedCentral
19.
Hohl CM, Robitaille C, Lord V, Dankoff J, Colacone A, Pham L, et al. Emergency physician recognition of adverse drug-related events in elder patients presenting to an emergency department. Acad Emerg Med. 2005;12(3):197–205.CrossRefPubMed
20.
Bannwarth B, Queneau P, Carpentier F, Guliana JM, Bouget J, Trombert B, et al. Hospital visits caused by adverse drug reactions: incidence and preventability assessed in French primary care/emergency departments. Drug Saf. 2003;26(2):133–4.CrossRefPubMed
21.
Malhotra S, Karan RS, Pandhi P, Jain S. Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance. Postgrad Med J. 2001;77(913):703–7.CrossRefPubMedPubMedCentral
22.
Olshaker JS, Barish RA, Naradzay JF, Jerrard DA, Safir E, Campbell L. Prescription noncompliance: contribution to emergency department visits and cost. J Emerg Med. 1999;17(5):909–12.CrossRefPubMed
23.
Tafreshi MJ, Melby MJ, Kaback KR, Nord TC. Medication-related visits to the emergency department: a prospective study. Ann Pharmacother. 1999;33(12):1252–7.CrossRefPubMed
24.
Hafner JW Jr, Belknap SM, Squillante MD, Bucheit KA. Adverse drug events in emergency department patients. Ann Emerg Med. 2002;39(3):258–67.CrossRefPubMed
25.
Hohl CM, Dankoff J, Colacone A, Afilalo M. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med. 2001;38(6):666–71.CrossRefPubMed
26.
Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis. 2008;47(6):735–43.CrossRefPubMed
27.
Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL. National surveillance of emergency department visits for outpatient adverse drug events. JAMA. 2006;296(15):1858–66.CrossRefPubMed
28.
Yee JL, Hasson NK, Schreiber DH. Drug-related emergency department visits in an elderly veteran population. Ann Pharmacother. 2005;39(12):1990–5.CrossRefPubMed
29.
Aparasu RR. Drug-related-injury visits to hospital emergency departments. American journal of health-system pharmacy. AJHP. 1998;55(11):1158–61.PubMed
30.
Aparasu RR. Visits to office-based physicians in the United States for medication-related morbidity. J Am Pharm Assoc. 1999;39(3):332–7.CrossRef
31.
Aparasu RR, Helgeland DL. Utilization of ambulatory care services caused by adverse effects of medications in the United States. Manag Care Interface. 2000;13(4):70–5.PubMed
32.
Smith KM, McAdams JW, Frenia ML, Todd MW. Drug-related problems in emergency department patients. AJHP. 1997;54(3):295–8.PubMed
33.
Schneitman-McIntire O, Farnen TA, Gordon N, Chan J, Toy WA. Medication misadventures resulting in emergency department visits at and HMO medical center. AJHP. 1996;53(12):1416–22.PubMed
34.
Dennehy CE, Kishi DT, Louie C. Drug-related illness in emergency department patients. Am J Health Syst. 1996;53(12):1422–6.
35.
Stoukides CA, D'Agostino PR, Kaufman MB. Adverse drug reaction surveillance in an emergency room. Am J Hosp Pharm. 1993;50(4):712–4.PubMed
36.
Prince BS, Goetz CM, Rihn TL, Olsky M. Drug-related emergency department visits and hospital admissions. Am J Hosp Pharm. 1992;49(7):1696–700.PubMed
37.
Patel P, Zed PJ. Drug-related visits to the emergency department: how big is the problem? Pharmacotherapy. 2002;22(7):915–23.CrossRefPubMed
38.
Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM, Group HS. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008;168(17):1890–6.PubMed
39.
Forster AJ, Clark HD, Menard A, Dupuis N, Chernish R, Chandok N, et al. Adverse events among medical patients after discharge from hospital. Can Med Assoc J. 2004;170(3):345–9.
40.
Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348(16):1556–64.CrossRefPubMed
41.
Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289(9):1107–16.CrossRefPubMed
42.
Thomsen LA, Winterstein AG, Sondergaard B, Haugbolle LS, Melander A. Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care. Ann Pharmacother. 2007;41(9):1411–26.CrossRefPubMed
43.
Tache SV, Sonnichsen A, Ashcroft DM. Prevalence of adverse drug events in ambulatory care: a systematic review. Ann Pharmacother. 2011;45(7–8):977–89.CrossRefPubMed
44.
Sikdar KC, Alaghehbandan R, Macdonald D, Barrett B, Collins KD, Gadag V. Adverse drug events among children presenting to a hospital emergency department in Newfoundland and Labrador, Canada. Pharmacoepidemiol Drug Saf. 2010;19(2):132–40.CrossRefPubMed
45.
Carnovale C, Brusadelli T, Zuccotti G, Beretta S, Sullo MG, Capuano A, et al. The importance of monitoring adverse drug reactions in pediatric patients: the results of a national surveillance program in Italy. Expert Opin Drug Saf. 2014;13(Suppl 1):S1–8.CrossRefPubMed
46.
Capuano A, Irpino A, Gallo M, Ferrante L, Illiano ML, Rinaldi B, et al. Regional surveillance of emergency-department visits for outpatient adverse drug events. Eur J Clin Pharmacol. 2009;65(7):721–8.CrossRefPubMed
47.
Raschetti R, Morgutti M, Menniti-Ippolito F, Belisari A, Rossignoli A, Longhini P, et al. Suspected adverse drug events requiring emergency department visits or hospital admissions. Eur J Clin Pharmacol. 1999;54(12):959–63.CrossRefPubMed
48.
Trifiro G, Calogero G, Ippolito FM, Cosentino M, Giuliani R, Conforti A, et al. Adverse drug events in emergency department population: a prospective Italian study. Pharmacoepidemiol Drug Saf. 2005;14(5):333–40.CrossRefPubMed
49.
Zed PJ, Black KJ, Fitzpatrick EA, Ackroyd-Stolarz S, Murphy NG, Curran JA, et al. Medication-related emergency department visits in pediatrics: a prospective observational study. Pediatrics. 2015;135(3):435–43.CrossRefPubMed
50.
Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–43.PubMed
51.
Feinstein JA, Feudtner C, Kempe A. Adverse drug event-related emergency department visits associated with complex chronic conditions. Pediatrics. 2014;133(6):e1575–85.CrossRefPubMed
52.
Easton-Carter KL, Chapman CB, Brien JE. Emergency department attendances associated with drug-related problems in paediatrics. J Paediatr Child Health. 2003;39(2):124–9.CrossRefPubMed
53.
Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. Ann Pharmacother. 1990;24(11):1093–7.
54.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239–45.CrossRefPubMed
55.
56.
Bousquet C, Sadou E, Souvignet J, Jaulent MC, Declerck G. Formalizing MedDRA to support semantic reasoning on adverse drug reaction terms. J Biomed Inform. 2014;49:282–91.CrossRefPubMed
57.
Cohen AL, Budnitz DS, Weidenbach KN, Jernigan DB, Schroeder TJ, Shehab N, et al. National surveillance of emergency department visits for outpatient adverse drug events in children and adolescents. J Pediatr. 2008;152(3):416–21.CrossRefPubMed
58.
Bourgeois FT, Mandl KD, Valim C, Shannon MW. Pediatric adverse drug events in the outpatient setting: an 11-year national analysis. Pediatrics. 2009;124(4):e744–50.CrossRefPubMedPubMedCentral
59.
Schillie SF, Shehab N, Thomas KE, Budnitz DS. Medication overdoses leading to emergency department visits among children. Am J Prev Med. 2009;37(3):181–7.CrossRefPubMed
60.
Phan H, Leder M, Fishley M, Moeller M, Nahata M. Off-label and unlicensed medication use and associated adverse drug events in a pediatric emergency department. Pediatr Emerg Care. 2010;26(6):424–30.CrossRefPubMed
61.
Martinez-Mir I, Garcia-Lopez M, Palop V, Ferrer JM, Estan L, Rubio E, et al. A prospective study of adverse drug reactions as a cause of admission to a paediatric hospital. Br J Clin Pharmacol. 1996;42(3):319–24.CrossRefPubMedPubMedCentral
62.
Lamabadusuriya SP, Sathiadas G. Adverse drug reactions in children requiring hospital admission. Ceylon Med J. 2003;48(3):86–7.PubMed
63.
Zed PJ, Haughn C, Black KJ, Fitzpatrick EA, Ackroyd-Stolarz S, Murphy NG, et al. Medication-related emergency department visits and hospital admissions in pediatric patients: a qualitative systematic review. J Pediatr. 2013;163(2):477–83.CrossRefPubMed
64.
Easton KL, Chapman CB, Brien JA. Frequency and characteristics of hospital admissions associated with drug-related problems in paediatrics. Br J Clin Pharmacol. 2004;57(5):611–5.CrossRefPubMedPubMedCentral
65.
Easton KL, Parsons BJ, Starr M, Brien JE. The incidence of drug-related problems as a cause of hospital admissions in children. Med J Aust. 1998;169(7):356–9.PubMed
66.
Ferrajolo C, Capuano A, Trifiro G, Moretti U, Rossi F, Santuccio C. Pediatric drug safety surveillance in Italian pharmacovigilance network: an overview of adverse drug reactions in the years 2001 - 2012. Expert Opin Drug Saf. 2014;13(Suppl 1):S9–20.CrossRefPubMed
67.
Zed PJ. Medication-Related Emergency Department Visits and Hospital Admissions in Pediatric Patients: A Qualitative Systematic Review. J Pediatr. 2013;163:477–83.CrossRefPubMed
68.
Kozer E, Berkovitch M, Koren G. Medication errors in children. Pediatr Clin N Am. 2006;53(6):1155–68.CrossRef
69.
70.
McGrady ME, Hommel KA. Medication adherence and health care utilization in pediatric chronic illness: a systematic review. Pediatrics. 2013;132(4):730–40.CrossRefPubMedPubMedCentral
Metadata
Title
Medication-related visits in a pediatric emergency department: an 8-years retrospective analysis
Authors
Cristiano Rosafio
Serena Paioli
Cinzia Del Giovane
Valentina Cenciarelli
Nilla Viani
Paolo Bertolani
Lorenzo Iughetti
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Italian Journal of Pediatrics / Issue 1/2017
Electronic ISSN: 1824-7288
DOI
https://doi.org/10.1186/s13052-017-0375-7

Other articles of this Issue 1/2017

Italian Journal of Pediatrics 1/2017 Go to the issue

Research

Long-term treatment with low-dose medicine in chronic childhood eczema: a double-blind two-stage randomized control trial

Case report

Congenital hypothyroidism due to ectopic sublingual thyroid gland in Prader-Willi Syndrome: a case report

Research

Bifidobacterium mixture (B longum BB536, B infantis M-63, B breve M-16V) treatment in children with seasonal allergic rhinitis and intermittent asthma

Research

Childhood obesity classification systems and cardiometabolic risk factors: a comparison of the Italian, World Health Organization and International Obesity Task Force references

Research

Unexpected episodes of cyanosis in late preterm and term neonates prompted admission to a neonatal care unit

Research

Chromosomal abnormalities: subgroup analysis by maternal age and perinatal features in zhejiang province of China, 2011–2015