CDC: Common Drugs Are Sending People to Emergency Room
The State (South Carolina)

A study released this week finds that four drugs are mainly responsible for most of the emergency room visits in the U.S.

The study, by researchers from the US Centers for Disease Control and Prevention, singles out four drugs and drug classes - warfarin, oral antiplatelet medications, insulins, and oral hypoglycemic agents. The study also noted that better management of antithrombotic and anti-diabetic drugs could help avoid thousands of emergency admissions.

The study, published Thursday in the New England Journal of Medicine, highlights a couple of key issues doctors and patients need to be acutely aware of. The first is adverse reactions to medication, and the second is unintentional overdoses.

According to researchers, nearly 100,000 hospitalizations every year are linked to adverse drug events such as allergic reactions and unintentional overdoses. Nearly half, or 48.1 percent, of those hospitalized were adults 80 years old or older.

'These data suggest that focusing safety initiatives on a few medicines that commonly cause serious, measurable harms can improve care for many older Americans,” said lead study author Dr. Daniel Budnitz, director of the CDC’s medication safety program. 'Blood thinners and diabetes medicines often require blood testing and dosing changes, but these are critical medicines for older adults with certain medical conditions.”

'Of the thousands of medications available to older patients, a small group of blood thinners and diabetes medications caused a high proportion of emergency hospitalizations for adverse drug events among elderly Americans,” he added.

The study comes as the Obama administration has sought to decrease the number of emergency room visits by upwards of 20 percent. The new healthcare law could results in nearly 32 million newly insured people visiting emergency rooms already crammed beyond capacity, according to experts on healthcare facilities. President Obama has urged preventative practices in order to lower the rate of emergency rooms visits.

****

This article is available to subscribers.
Sign in now if you're a subscriber.
Free Preview PRINT E-MAIL DOWNLOAD CITATION
SPECIAL ARTICLE
Emergency Hospitalizations for Adverse Drug Events in Older Americans

Daniel S. Budnitz, M.D., M.P.H., Maribeth C. Lovegrove, M.P.H., Nadine Shehab, Pharm.D., M.P.H., and Chesley L. Richards, M.D., M.P.H.
N Engl J Med 2011; 365:2002-2012November 24, 2011
BACKGROUND
Adverse drug events are important preventable causes of hospitalization in older adults. However, nationally representative data on adverse drug events that result in hospitalization in this population have been limited.
METHODS
We used adverse-event data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project (2007 through 2009) to estimate the frequency and rates of hospitalization after emergency department visits for adverse drug events in older adults and to assess the contribution of specific medications, including those identified as high-risk or potentially inappropriate by national quality measures.
RESULTS
On the basis of 5077 cases identified in our sample, there were an estimated 99,628 emergency hospitalizations (95% confidence interval [CI], 55,531 to 143,724) for adverse drug events in U.S. adults 65 years of age or older each year from 2007 through 2009. Nearly half of these hospitalizations were among adults 80 years of age or older (48.1%; 95% CI, 44.6 to 51.6). Nearly two thirds of hospitalizations were due to unintentional overdoses (65.7%; 95% CI, 60.1 to 71.3). Four medications or medication classes were implicated alone or in combination in 67.0% (95% CI, 60.0 to 74.1) of hospitalizations: warfarin (33.3%), insulins (13.9%), oral antiplatelet agents (13.3%), and oral hypoglycemic agents (10.7%). High-risk medications were implicated in only 1.2% (95% CI, 0.7 to 1.7) of hospitalizations.
CONCLUSIONS
Most emergency hospitalizations for recognized adverse drug events in older adults resulted from a few commonly used medications, and relatively few resulted from medications typically designated as high-risk or inappropriate. Improved management of antithrombotic and antidiabetic drugs has the potential to reduce hospitalizations for adverse drug events in older adults.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
We thank Kelly Weidenbach, M.P.H., and Victor Johnson of Northrop Grumman (contractors for the Centers for Disease Control and Prevention) and Cathy Irish, B.S., and Joel Friedman, B.A., of the U.S. Consumer Product Safety Commission for assistance with data collection and processing.
SOURCE INFORMATION

From the Division of Healthcare Quality Promotion (D.S.B., M.C.L., N.S.), the Office of Prevention through Healthcare (C.L.R.), Centers for Disease Control and Prevention, and the Division of Geriatrics and Gerontology, Emory University School of Medicine (C.L.R.) — all in Atlanta.
Address reprint requests to Dr. Budnitz at the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd., NE, Mailstop A-24, Atlanta, GA 30333, or at [email protected].
Access this article: Subscribe to NEJM |