COMMENTARY

Adverse Drug Events That Bring Kids to the Emergency Department

William T. Basco, Jr., MD, MS

Disclosures

May 23, 2017

Outpatient Pediatric Adverse Drug Events

Most of the literature and safety initiatives around adverse drug events (ADEs) concern inpatient prescribing. Therefore, a recent study[1] sought to describe the patterns and drugs involved in outpatient ADEs. The study evaluated 2013-2014 data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance Project, which collates ADEs from a stratified national sample of hospital emergency departments (EDs).

Both prescribed and over-the-counter drugs as well as vaccines, nutritional supplements and vitamins, and homeopathic products were included in this study. The mechanism of ADE, such as dosing or scheduling error, route error, incorrect drug administration, ingestion, or allergic reaction, was recorded for each ADE.

Among all children, the most frequent ADEs (37%) were a supratherapeutic effect from taking an appropriate dose or an excess dose; allergic reactions (28%) were next in frequency, "other" ADEs (26%) were third, and unsupervised ingestion of a drug (5%) was substantially less common.

One fourth of the ED visits for ADEs resulted in a hospitalization. Among children aged 19 years or younger, antibiotics were among the most frequent drugs associated with ADEs, led by amoxicillin at 21.5% of ADEs. The second most common category associated with ADEs was psychoactive drugs. Two substances each accounted for about 1% of childhood ADEs—methylphenidate and risperidone. Vaccines accounted for 19.5% of ADEs for children aged 5 years or younger and 3.7% of ADEs for those aged 6-19 years. Opioid analgesics accounted for 0.6% of ADEs for children aged 5 years or younger and 3% for those aged 6-19 years.

Viewpoint

The findings from this report, published late in 2016, are very pertinent to daily practice. Antibiotics are the most common drugs prescribed to children; and, as a class, they contributed to the greatest proportion of ADEs in this study. For children younger than 6 years, vaccines accounted for one of every five ADEs. This study reminds us that it's easy to lose sight of complications associated with these commonly prescribed drugs. In addition, the contribution of antipsychotics to ADE rates can't be overstated and emphasizes the need to closely monitor children for whom these drugs are prescribed. Finally, inadvertent ingestion of drugs accounted for almost 5% of ADEs among all children, pointing out the need to remind parents about safe drug storage.

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