US Emergency Department Visits Attributed to Medication Harms
- Medication-related visits to the emergency department (ED) are common, but vary by age.
- Anticoagulant medications are the most common reason for medication-related ED visits in older adults.
- Clopidogrel is a leading cause of ED visits for medication-related harms in the United States.
What are the characteristics of emergency department (ED) visits for acute harms from both therapeutic and nontherapeutic medication use in the United States?
The authors used a nationally representative, public health surveillance based on visits to 60 EDs in the United States between 2017–2019. Nationally weighted estimates of ED visits and subsequent hospitalizations for medication harms were assessed.
Based on 96,925 cases (mean age 49 years, 55% female), there were an estimated 6.1 (95% confidence interval [CI], 4.8-7.5) ED visits per 1,000 population annually, with 38.6% (95% CI, 35.2-41.9%) resulting in hospitalization. Overall, 69.1% (95% CI, 63.6-74.7%) of ED visits involved therapeutic medication use. By age group, the most frequent medication types resulting in ED visits were anticoagulants (4.5 [2.3-6.7] per 1,000 population) and diabetes agents (1.8 [1.3-2.3] per 1,000 population) for patients aged 65 years and older; diabetes agents (0.8 [0.5-1.0] per 1,000 population) for patients aged 45-64 years; and nontherapeutic use of benzodiazepines (1.0 [0.7-1.3] per 1,000 population) for patients aged 25-44 years. Among patients aged 65 years and older, the top five medications leading to ED visits were warfarin, insulin, clopidogrel, apixaban, and rivaroxaban.
The authors concluded that ED visits attributed to medication harms in 2017–2019 were frequent and varied by age.
As clinicians, we primarily focus on the therapeutic benefit when prescribing medications. However, many of these medications have risks that can lead to ED visits and hospitalizations. As these authors previously showed in 2016 (Shehab N, et al., JAMA 2016;316:2115-25), anticoagulants and diabetes medications are two of the most common drug classes leading to ED visits. Furthermore, clopidogrel is among the top medications leading to ED visits for older adults. Individual clinicians and health systems have an obligation to develop and implement strategies aimed at reducing medication-related harm that leads to ED visit. These strategies include reducing multiple antithrombotic use (e.g., anticoagulant plus aspirin) whenever possible, ensuring appropriate dosing by indication and renal function, and reducing other medications that increase bleeding risk (e.g., nonsteroidal anti-inflammatory drugs).
Keywords: Acute Coronary Syndrome, Anticoagulants, Anti-Inflammatory Agents, Non-Steroidal, Aspirin, Benzodiazepines, Clopidogrel, Diabetes Mellitus, Emergency Service, Hospital, Fibrinolytic Agents, Geriatrics, Myocardial Ischemia, Pharmaceutical Preparations, Primary Prevention, Rivaroxaban, Vascular Diseases, Warfarin
< Back to Listings