title: Emergency physician recognition of adverse drug-related events in elder patients presenting to an emergency department.
abstract: OBJECTIVE
  The authors examined the ability of emergency physicians (EPs) to recognize adverse drug-related events (ADREs) in elder patients presenting to the emergency department (ED).
  
  
  METHODS
  This was a prospective observational study of patients at least 65 years of age who presented to the ED. ADREs were identified using a validated, standardized scoring system. EP recognition of ADREs was assessed through physician interview and subsequent chart review.
  
  
  RESULTS
  A total of 161 patients were enrolled in the study. Thirty-seven ADREs were identified, which occurred in 26 patients (16.2%; 95% confidence interval [CI] = 10.5% to 22.0%). The treating EPs recognized 51.2% (95% CI = 35.2% to 67.4%) of all ADREs. There was better recognition of those ADREs related to the patient's chief complaint (91%; 95% CI = 74.1% to 100%) as compared with recognition of ADREs that were not associated with the chief complaint (32.1%; 95% CI = 14.8% to 49%). EPs recognized six of seven severe ADREs (85.7%), 13 of 23 moderate ADREs (56.5%; 95% CI = 36.8% to 77%), and none of the mild ADREs. Recognition of ADREs varied with medication class.
  
  
  CONCLUSIONS
  EP performance was superior at identifying severe ADREs relating to the patients' chief complaints. However, EP performance was suboptimal with respect to identifying ADREs of lower severity, having missed a significant number of ADREs of moderate severity as well as ones unrelated to the patients' chief complaints. ADRE detection methods need to be developed for the ED to aid EPs in detecting those ADREs that are most likely to be missed.
authors.affiliation: Emergency Department, Vancouver General Hospital, 885 West 12th Avenue, Vancouver, British Columbia, Canada. corinnehohl@yahoo.ca
authors.forename: Corinne Michèle
authors.initials: CM
authors.lastname: Hohl
authors.forename: Caroline
authors.initials: C
authors.lastname: Robitaille
authors.forename: Vicky
authors.initials: V
authors.lastname: Lord
authors.forename: Jerrald
authors.initials: J
authors.lastname: Dankoff
authors.forename: Antoinette
authors.initials: A
authors.lastname: Colacone
authors.forename: Luc
authors.initials: L
authors.lastname: Pham
authors.forename: Anick
authors.initials: A
authors.lastname: Bérard
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Pépin
authors.forename: Marc
authors.initials: M
authors.lastname: Afilalo
mesh_terms: D000368:Aged; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004358:Drug Therapy / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions; D004635:Emergency Medicine / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D011792:Quebec