Trends in emergency department visits attributable to acetaminophen overdoses in the United States: 1993-2007

Abstract

Purpose: With the heightened concern over acetaminophen overdose induced liver toxicity, it is important to track the overdose incidences over time. We estimated the trends in emergency department (ED) visits attributable to acetaminophen overdoses and compared the risk across sociodemographic groups and geographic regions.

Methods: ED visits attributable to acetaminophen overdoses were identified using physician diagnosis codes and cause of injury codes from the National Hospital Ambulatory Medical Care Survey (1993-2007). Annual rates of ED visits for acetaminophen overdoses per 100,000 persons in the U.S. population and by subgroups (age, gender, race, insurance coverage, geographic region, and presence of alcohol abuse and dependence) were calculated. Bivariate analysis and logistic regressions were used to examine the associations of patient demographic characteristics with ED visits for acetaminophen overdoses. Data were analyzed using STATA 9.2 accounting for complex survey design.

Results: From 1993 through 2007, an estimated 751,552 ED visits (0.05% of all ED visits) were attributable to acetaminophen overdoses. The annual rate per 100,000 persons was significantly higher prior to 2000 (21.0 visits in 1993-1999 vs. 15.2 visits in 2000-2007, p = 0.017). Rates were particularly high in young children under 5 years (72.4 visits, 95% confidence interval (CI): 49.1-95.8) and for adolescents between 15-17 years (61.8 visits, 95%CI: 35.4-88.3). Rates also varied cross gender, insurance coverage, and geographic regions.

Conclusions: ED visits attributable to acetaminophen overdose decreased in recent years. Children less than 5 years of age, adolescents and young adults account for the overwhelming majority of these visits.