Katja S Just1, Harald Dormann2, Miriam Böhme3, Marlen Schurig3, Katharina L Schneider3, Michael Steffens3, Sandra Dunow3, Bettina Plank-Kiegele2, Kristin Ettrich4, Thomas Seufferlein4, Ingo Gräff5, Svitlana Igel6,7, Severin Schricker8, Simon U Jaeger6,9, Matthias Schwab6,7,10,9, Julia C Stingl11. 1. Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany. 2. Central Emergency Department, Hospital Fürth, Furth, Germany. 3. Research Department, Federal Institute for Drugs and Medical Devices, Bonn, Germany. 4. Internal Medicine Emergency Department, Ulm University Medical Centre, Ulm, Germany. 5. Interdisciplinary Emergency Department (INZ), University Hospital of Bonn, Bonn, Germany. 6. Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Robert-Bosch-Hospital, Stuttgart, Germany. 7. University of Tuebingen, Tuebingen, Germany. 8. Department of Internal Medicine, Division of General Internal Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany. 9. Department of Clinical Pharmacology, University Hospital Tuebingen, Tuebingen, Germany. 10. Department of Pharmacy and Biochemistry, University of Tuebingen, Tuebingen, Germany. 11. Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany. jstingl@ukaachen.de.
Abstract
PURPOSE: Adverse drug reactions (ADR) account for 5 to 7% of emergency department (ED) consultations. We aimed to assess medication risk profiles for ADRs leading to ED visits. METHODS: We analysed medication intake and patient demographics in a prospective multi-centre observational study collecting ADR cases in four large EDs in Germany. Odds ratios (OR) were calculated to relate drug classes taken to those suspicious for an ADR after a causality assessment. RESULTS: A total of 2215 cases of ED visits due to ADRs were collected. The median age of the cohort was 73 years; in median, six co-morbidities and an intake of seven drugs were documented. Antineoplastic/immunomodulating agents had the highest OR for being suspected for an ADR (OR 20.45, 95% CI 14.54-28.77), followed by antithrombotics (OR 2.94, 95% CI 2.49-3.47), antibiotics (OR 2.65, 95% CI 1.78-3.95), systemic glucocorticoids (OR 2.43, 95% CI 1.54-3.82) and drugs affecting the central nervous system (CNS), such as antipsychotics (OR 2.36, 95% CI 1.46-3.81), antidepressants (OR 2.10, 95% CI 1.57-2.83), antiparkinsonian medication (OR 2.11, 95% CI 1.15-3.84), opioids (OR 1.79, 95% CI 1.26-2.54) and non-opioid analgesics (OR 1.32, 95% CI 1.01-1.72). CONCLUSIONS: Patients experiencing ADRs leading to ED visits are commonly old, multi-morbid and multi-medicated. CNS drugs may be more relevant than prior expected. With calculating ORs, we could replicate involvement of antineoplastic agents, antithrombotics, antibiotics, systemic glucocorticoids and non-opioid analgesics as frequently suspected for ADRs in EDs. TRIAL REGISTRATION: DRKS-ID: DRKS00008979.
PURPOSE: Adverse drug reactions (ADR) account for 5 to 7% of emergency department (ED) consultations. We aimed to assess medication risk profiles for ADRs leading to ED visits. METHODS: We analysed medication intake and patient demographics in a prospective multi-centre observational study collecting ADR cases in four large EDs in Germany. Odds ratios (OR) were calculated to relate drug classes taken to those suspicious for an ADR after a causality assessment. RESULTS: A total of 2215 cases of ED visits due to ADRs were collected. The median age of the cohort was 73 years; in median, six co-morbidities and an intake of seven drugs were documented. Antineoplastic/immunomodulating agents had the highest OR for being suspected for an ADR (OR 20.45, 95% CI 14.54-28.77), followed by antithrombotics (OR 2.94, 95% CI 2.49-3.47), antibiotics (OR 2.65, 95% CI 1.78-3.95), systemic glucocorticoids (OR 2.43, 95% CI 1.54-3.82) and drugs affecting the central nervous system (CNS), such as antipsychotics (OR 2.36, 95% CI 1.46-3.81), antidepressants (OR 2.10, 95% CI 1.57-2.83), antiparkinsonian medication (OR 2.11, 95% CI 1.15-3.84), opioids (OR 1.79, 95% CI 1.26-2.54) and non-opioid analgesics (OR 1.32, 95% CI 1.01-1.72). CONCLUSIONS:Patients experiencing ADRs leading to ED visits are commonly old, multi-morbid and multi-medicated. CNS drugs may be more relevant than prior expected. With calculating ORs, we could replicate involvement of antineoplastic agents, antithrombotics, antibiotics, systemic glucocorticoids and non-opioid analgesics as frequently suspected for ADRs in EDs. TRIAL REGISTRATION: DRKS-ID: DRKS00008979.
Entities:
Keywords:
Adverse drug reaction; Drug class; Drug safety; Emergency department; Medication; Older adults
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