Outcomes of Emergency Department Patients Presenting With Adverse Drug Events

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• 作者：Corinne M.  ; Hohl MD ; FRCP(C) ; MHSc^a ;   ; ^b ;   ; ^c ;   ; ^{chohl@interchange.ubc.ca} ; Bohdan  ; Nosyk PhD^d ; Lisa  ; Kuramoto MSc^c ; Peter J.  ; Zed PharmD^e ; Jeffrey R.  ; Brubacher MD ; FRCP(C) ; MSc^a ;   ; ^b ;   ; ^c ; Riyad B.  ; Abu-Laban MD ; FRCP(C) ; MHSc^a ;   ; ^b ;   ; ^c ; Samuel B.  ; Sheps MD ; FRCP(C) ; MSc^f ; Boris  ; Sobolev PhD^c ;   ; ^f
• 刊名：Annals of Emergency Medicine
• 出版年：2011
• 出版时间：September 2011
• 年：2011
• 卷：58
• 期：3
• 页码：270-279.e4
• 全文大小：1101 K

文摘

Study objective

Our objectives are to describe the outcomes of patients presenting to the emergency department (ED) because of an adverse drug event and to compare them with outcomes of patients presenting for other reasons.

Methods

This prospective observational study was conducted at Vancouver General Hospital, a 955-bed tertiary care hospital. We prospectively enrolled adults presenting to the ED between March and June 2006, using a systematic sampling algorithm. Pharmacists and physicians independently evaluated patients for adverse drug events. An independent committee reviewed and adjudicated cases in which assessments were discordant or uncertain. Data from the index visit were linked to vital statistics, administrative health services utilization, and cost of care data.

Results

Of 1,000 patients, 122 (12.2 % ; 95 % confidence interval [CI] 10.3 % to 14.4 % ) presented to the ED because of an adverse drug event. Of these, 48 presented because of an adverse drug reaction (one type of adverse drug event defined as an unintended response that occurred despite use of an appropriate drug dosage). We found no difference in mortality among patients presenting with and without adverse drug reactions (14.6 % versus 5.9 % ; hazard ratio 1.57; 95 % CI 0.70 to 3.52). After adjustment, patients with adverse drug events had a higher risk of spending additional days in the hospital per month (6.3 % versus 3.4 % ; odds ratio 1.52; 95 % CI 1.43 to 1.62) and higher rate of outpatient health care encounters (1.73 versus 1.22; rate ratio 1.20; 95 % CI 1.03 to 1.40). The adjusted median monthly cost of care was 1.90 times higher (Can $325 versus $96; 95 % CI 1.18 to 3.08).

Conclusion

ED patients presenting with an adverse drug event incurred greater health services utilization and costs during a 6-month follow-up period compared with patients presenting for other reasons.