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. 2013 Mar 5:21:15.
doi: 10.1186/1757-7241-21-15.

Drug-related emergency department visits by elderly patients presenting with non-specific complaints

Christian H Nickel  1 , Juliane M Ruedinger, Anna S Messmer, Silke Maile, Arno Peng, Michael Bodmer, Reto W Kressig, Stephan Kraehenbuehl, Roland Bingisser
Affiliations

Drug-related emergency department visits by elderly patients presenting with non-specific complaints

Christian H Nickel et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Since drug-related emergency department (ED) visits are common among older adults, the objectives of our study were to identify the frequency of drug-related problems (DRPs) among patients presenting to the ED with non-specific complaints (NSC), such as generalized weakness and to evaluate responsible drug classes.

Methods: Delayed type cross-sectional diagnostic study with a prospective 30 day follow-up in the ED of the University Hospital Basel, Switzerland. From May 2007 until April 2009, all non-trauma patients presenting to the ED with an Emergency Severity Index (ESI) of 2 or 3 were screened and included, if they presented with non-specific complaints. After having obtained complete 30-day follow-up, two outcome assessors reviewed all available information, judged whether the initial presentation was a DRP and compared their judgment with the initial ED diagnosis. Acute morbidity ("serious condition") was allocated to individual cases according to predefined criteria.

Results: The study population consisted of 633 patients with NSC. Median age was 81 years (IQR 72/87), and the mean Charlson comorbidity index was 2.5 (IQR 1/4). DRPs were identified in 77 of the 633 cases (12.2%). At the initial assessment, only 40% of the DRPs were correctly identified. 64 of the 77 identified DRPs (83%) fulfilled the criteria "serious condition". Polypharmacy and certain drug classes (thiazides, antidepressants, benzodiazepines, anticonvulsants) were associated with DRPs.

Conclusion: Elderly patients with non-specific complaints need to be screened systematically for drug-related problems.

Trial registration: ClinicalTrials.gov: NCT00920491.

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Figures

Figure 1
Figure 1
Study outline.
Figure 2
Figure 2
PCNE Classification and percentage of all our identified drug-related problems (DRP), N = 77. It has six primary domains for problems: P1 = adverse drug reactions, P2 = Drug choice problem, P3 = Dosing problem, P4 = Drug use problem, P5 = Interactions, P6 = other.
See this image and copyright information in PMC

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