title: Medication-related emergency department visits in pediatrics: a prospective observational study.
abstract: OBJECTIVE
  There are few data on the rate and characterization of medication-related visits (MRVs) to the emergency department (ED) in pediatric patients. We sought to evaluate the frequency, severity, preventability, and classification of MRVs to the ED in pediatric patients.
  
  
  METHODS
  We performed a prospective observational study of pediatric patients presenting to the ED over a 12-month period. A medication-related ED visit was identified by using pharmacist assessment, emergency physician assessment, and an independent adjudication committee.
  
  
  RESULTS
  In this study, 2028 patients were enrolled (mean age, 6.1 ± 5.0 years; girls, 47.4%). An MRV was found in 163 patients (8.0%; 95% confidence interval [CI]: 7.0%-9.3%) of which 106 (65.0%; 95% CI: 57.2%-72.3%) were deemed preventable. Severity was classified as mild in 14 cases (8.6%; 95% CI: 4.8%-14.0%), moderate in 140 cases (85.9%; 95% CI: 79.6%-90.8%), and severe in 9 cases (5.5%; 95% CI: 2.6%-10.2%). The most common events were related to adverse drug reactions 26.4% (95% CI: 19.8%-33.8%), subtherapeutic dosage 19.0% (95% CI: 13.3%-25.9%), and nonadherence 17.2% (95% CI: 11.7%-23.9%). The probability of hospital admission was significantly higher among patients with an MRV compared with those without an MRV (odds ratio, 6.5; 95% CI: 4.3-9.6) and, if admitted, the median (interquartile range) length of stay was longer (3.0 [5.0] days vs 1.5 [2.5] days, P = .02).
  
  
  CONCLUSIONS
  A medication-related cause was found in ∼1 of every 12 ED visits by pediatric patients, of which two-thirds were deemed preventable. Pediatric patients who present to the ED with an MRV are more likely to be admitted to hospital and when admitted have a longer length of stay.
authors: Faculty of Pharmaceutical Sciences, Department of Emergency Medicine, Faculty of Medicine, and peter.zed@ubc.ca.
authors: Peter J
authors: PJ
authors: Zed
authors: Division of Emergency Medicine, Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada; University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada;
authors: Karen J L
authors: KJ
authors: Black
authors: Departments of Emergency Medicine and Department of Emergency Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada;
authors: Eleanor A
authors: EA
authors: Fitzpatrick
authors: Departments of Emergency Medicine and Performance Excellence, and.
authors: Stacy
authors: S
authors: Ackroyd-Stolarz
authors: Departments of Emergency Medicine and IWK Regional Poison Control Centre, Halifax, Nova Scotia, Canada; Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Capital Health, Halifax, Nova Scotia, Canada;
authors: Nancy G
authors: NG
authors: Murphy
authors: Departments of Emergency Medicine and Department of Emergency Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada; School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada;
authors: Janet A
authors: JA
authors: Curran
authors: James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio; and.
authors: Neil J
authors: NJ
authors: MacKinnon
authors: St. Michael's Hospital, Toronto, Ontario, Canada.
authors: Doug
authors: D
authors: Sinclair
mesh_terms: D000293:Adolescent; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000628:therapy; D004630:Emergencies / Q000453:epidemiology*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D055815:Young Adult
keywords: adverse drug events; adverse drug reaction; adverse events; emergency department; hospitalization; patient safety; pediatrics