Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Shehab N et al. JAMA 2016 Nov 22/29. Kessler C et al. JAMA 2016 Nov 22/29.

In older adults, antithrombotic drugs, antidiabetes drugs, and opioids accounted for three fourths of these visits.

Adverse drug events (ADEs) pose substantial risk for patients, including emergency department (ED) visits and hospitalizations (NEJM JW Hosp Med Jan 2012 and N Engl J Med 2011; 365:2002). In this new study, investigators used a U.S. national surveillance database to estimate that, each year, 4 in 1000 people (0.4%) visit EDs due to ADEs (1 in 4 such visits result in hospitalization). In older Americans, the annual ED visit rate due to ADEs is even higher (1%), with nearly half of such visits resulting in hospitalization.

Whereas ED visits among children usually were due to ADEs caused by antibiotics and antipsychotics, three fourths of ADEs among older adults were caused by four drug classes — anticoagulants, antiplatelet agents, antidiabetic drugs, and opioid analgesics. Beers list medications (i.e., medications to avoid in older patients) were responsible for <4% of all ADE visits to EDs among elders.

CITATION(S):

Shehab N et al. US Emergency department visits for outpatient adverse drug events, 2013–2014. JAMA 2016 Nov 22/29; 316:2115.

Kessler C et al. Reducing adverse drug events: The need to rethink outpatient prescribing. JAMA 2016 Nov 22/29; 316:2092. 

JWatch