title: Emergency hospitalizations for unsupervised prescription medication ingestions by young children.
abstract: BACKGROUND
  Emergency department visits and subsequent hospitalizations of young children after unsupervised ingestions of prescription medications are increasing despite widespread use of child-resistant packaging and caregiver education efforts. Data on the medications implicated in ingestions are limited but could help identify prevention priorities and intervention strategies.
  
  
  METHODS
  We used nationally representative adverse drug event data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and national retail pharmacy prescription data from IMS Health to estimate the frequency and rates of emergency hospitalizations for unsupervised prescription medication ingestions by young children (2007-2011).
  
  
  RESULTS
  On the basis of 1513 surveillance cases, 9490 estimated emergency hospitalizations (95% confidence interval: 6420-12,560) occurred annually in the United States for unsupervised prescription medication ingestions among children aged <6 years from 2007 through 2011; 75.4% involved 1- or 2-year old children. Opioids (17.6%) and benzodiazepines (10.1%) were the most commonly implicated medication classes. The most commonly implicated active ingredients were buprenorphine (7.7%) and clonidine (7.4%). The top 12 active ingredients, alone or in combination with others, were implicated in nearly half (45.0%) of hospitalizations. Accounting for the number of unique patients who received dispensed prescriptions, the hospitalization rate for unsupervised ingestion of buprenorphine products was significantly higher than rates for all other commonly implicated medications and 97-fold higher than the rate for oxycodone products (200.1 vs 2.1 hospitalizations per 100,000 unique patients).
  
  
  CONCLUSIONS
  Focusing unsupervised ingestion prevention efforts on medications with the highest hospitalization rates may efficiently achieve large public health impact.
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; mlovegrove@cdc.gov.
authors.forename: Maribeth C
authors.initials: MC
authors.lastname: Lovegrove
authors.affiliation: Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland; and.
authors.forename: Justin
authors.initials: J
authors.lastname: Mathew
authors.affiliation: Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland; and.
authors.forename: Christian
authors.initials: C
authors.lastname: Hampp
authors.affiliation: Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland; and AstraZeneca, Patient Safety, Gaithersburg, Maryland.
authors.forename: Laura
authors.initials: L
authors.lastname: Governale
authors.affiliation: Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland; and.
authors.forename: Diane K
authors.initials: DK
authors.lastname: Wysowski
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Budnitz
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000639:trends*; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007223:Infant; D008297:Male; D055553:Prescription Drugs / Q000009:adverse effects*
chemical_list: D055553:Prescription Drugs
keywords: buprenorphine; drug packaging; opioids; pediatric hospitalization; poisoning; prescription drugs; sulfonylureas; unintentional overdose