Elsevier

The Journal of Pediatrics

Volume 152, Issue 3, March 2008, Pages 416-421.e2
The Journal of Pediatrics

Original article
National Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events in Children and Adolescents

https://doi.org/10.1016/j.jpeds.2007.07.041Get rights and content

Objective

To describe the national scope and magnitude of outpatient adverse drug events (ADEs) that lead to emergency department (ED) visits in children and adolescents.

Study design

To conduct an active surveillance of patients 18 years of age or younger who came to EDs with ADEs from Jan 1, 2004, to Dec 31, 2005, through a nationally representative, stratified probability sample of 63 US hospitals with EDs. The main outcome measures were national estimates of the number, type, patient demographics, and clinical characteristics of ADEs.

Results

Annually, an estimated 158,520 patients ≤18 years old (95% CI, 117,745-199,295; 2 per 1000 persons) were treated in EDs for ADEs. Almost half (49.4%) of these visits occurred in patients between 1 and 4 years of age. Unintentional overdoses were the most common type of ADE (44.9%), followed by allergic reactions (35%), and adverse effects (12.6%). Antimicrobial agents, analgesic medications, and respiratory medications accounted for almost half of ADEs (25.2%, 13.7%, and 10.6%, respectively). Fewer than 1 in 10 patients (9.5%) required hospitalization or extended observation.

Conclusions

Interventions targeting unintentional overdoses of medications commonly given to preschool-aged children would likely have the highest impact in reducing ED visits from outpatient ADEs.

Section snippets

Methods

We conducted active surveillance through the National Electronic Injury Surveillance System–Cooperative Adverse Event Surveillance project (NEISS-CADES), a national stratified probability sample of 63 hospitals in the United States and its territories with a minimum of 6 beds and either a 24-hour adult or pediatric ED.12 All the hospitals treat pediatric or adolescent patients; five of the hospitals (7.9%) are exlusively pediatric hospitals. NEISS-CADES is a joint effort of the Centers for

National Estimates

Annually, an estimated 158,520 patients ≤18 years of age (95% CI, 117,745-199,295; 6681 cases) were treated in EDs for ADEs in 2004 and 2005. The population rate of ADEs in patients ≤18 years old was 2 per 1000 persons (95% CI, 1.5-2.6 per 1000 persons). Almost half (49.4%) of these ADEs occurred in patients between 1 and 4 years of age, and 12.4% of these ADEs occurred in infants <1 year old (Table I). The rate of ADEs in children <5 years of age was >4 times higher than the rate in children

Discussion

ADEs pose a significant pediatric health burden in the United States. Compared with estimates of other injuries, we found that in 2004 and 2005 ADEs were the third leading cause of nonfatal injuries treated in hospital EDs in infants <1 year of age and the sixth leading cause of nonfatal injuries in children 1 to 4 years old.19 One third of the estimated 158,520 pediatric ADEs were unintentional overdoses in toddlers, most commonly from analgesic and respiratory medications. More than one third

References (31)

  • D.W. Bates et al.

    Incidence of adverse drug events and potential adverse drug eventsImplications for prevention

    JAMA

    (1995)
  • R. Kaushal et al.

    Medication errors and adverse drug events in pediatric inpatients

    JAMA

    (2001)
  • D.S. Budnitz et al.

    National surveillance of emergency department visits for outpatient adverse drug events

    JAMA

    (2006)
  • National Electronic Injury Surveillance System All Injury Program sample design and implementation

    (2002)
  • Assessing the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project—six sites, United States, January 1-June 15, 2004

    MMWR Morb Mortal Wkly Rep

    (2005)
  • Cited by (80)

    • Judicious antibiotic prescribing in ambulatory pediatrics: Communication is key

      2018, Current Problems in Pediatric and Adolescent Health Care
    View all citing articles on Scopus
    View full text