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Original Investigation
October 5, 2021

US Emergency Department Visits Attributed to Medication Harms, 2017-2019

Author Affiliations
  • 1Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 2Lantana Consulting Group, Atlanta, Georgia
JAMA. 2021;326(13):1299-1309. doi:10.1001/jama.2021.13844
Key Points

Question  What were the most frequent medication types and intents of use associated with emergency department (ED) visits for medication harms in the US in 2017-2019?

Findings  In this cross-sectional nationally representative sample that included 60 US EDs between 2017 and 2019, annual estimates of the most frequent medication types and intents of use associated with ED visits attributed to medication harms (adverse events) were therapeutic use of anticoagulants (4.5/1000 population) and diabetes agents (1.8/1000 population) for patients aged 65 years or older; therapeutic use of anticoagulants (0.6/1000 population) and diabetes agents (0.8/1000 population) for patients aged 45 to 64 years; nontherapeutic use of benzodiazepines (1.0/1000 population) and prescription opioids (0.7/1000 population) for patients aged 25 to 44 years; and unsupervised medication exposures (2.2/1000 population) and therapeutic use of antibiotics (1.4/1000 population) for children younger than 5 years.

Meaning  Visits to US EDs attributed to medication harms in 2017-2019 were frequent and varied by medication type, intended use, and patient age.

Abstract

Importance  Assessing the scope of acute medication harms to patients should include both therapeutic and nontherapeutic medication use.

Objective  To describe the characteristics of emergency department (ED) visits for acute harms from both therapeutic and nontherapeutic medication use in the US.

Design, Setting, and Participants  Active, nationally representative, public health surveillance based on patient visits to 60 EDs in the US participating in the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance Project from 2017 through 2019.

Exposures  Medications implicated in ED visits, with visits attributed to medication harms (adverse events) based on the clinicians’ diagnoses and supporting data documented in the medical record.

Main Outcomes and Measures  Nationally weighted estimates of ED visits and subsequent hospitalizations for medication harms.

Results  Based on 96 925 cases (mean patient age, 49 years; 55% female), there were an estimated 6.1 (95% CI, 4.8-7.5) ED visits for medication harms per 1000 population annually and 38.6% (95% CI, 35.2%-41.9%) resulted in hospitalization. Population rates of ED visits for medication harms were higher for patients aged 65 years or older than for those younger than 65 years (12.1 vs 5.0 [95% CI, 7.4-16.8 vs 4.1-5.8] per 1000 population). Overall, an estimated 69.1% (95% CI, 63.6%-74.7%) of ED visits for medication harms involved therapeutic medication use, but among patients younger than 45 years, an estimated 52.5% (95% CI, 48.1%-56.8%) of visits for medication harms involved nontherapeutic use. The proportions of ED visits for medication harms involving therapeutic use were lowest for barbiturates (6.3%), benzodiazepines (11.1%), nonopioid analgesics (15.7%), and antihistamines (21.8%). By age group, the most frequent medication types and intents of use associated with ED visits for medication harms were therapeutic use of anticoagulants (4.5 [95% CI, 2.3-6.7] per 1000 population) and diabetes agents (1.8 [95% CI, 1.3-2.3] per 1000 population) for patients aged 65 years and older; therapeutic use of diabetes agents (0.8 [95% CI, 0.5-1.0] per 1000 population) for patients aged 45 to 64 years; nontherapeutic use of benzodiazepines (1.0 [95% CI, 0.7-1.3] per 1000 population) for patients aged 25 to 44 years; and unsupervised medication exposures (2.2 [95% CI, 1.8-2.7] per 1000 population) and therapeutic use of antibiotics (1.4 [95% CI, 1.0-1.8] per 1000 population) for children younger than 5 years.

Conclusions and Relevance  According to data from 60 nationally representative US emergency departments, visits attributed to medication harms in 2017-2019 were frequent, with variation in products and intent of use by age.

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