Frequency, Characteristics, and Predictive Factors of Adverse Drug Events in an Adult Emergency Department according to Age: A Cross-Sectional Study

Abstract

Adverse drug events (ADEs) are a major public health concern, given their consequences in terms of morbi-mortality and associated healthcare costs. Many studies have focused on the elderly, who are considered particularly vulnerable in this respect. We aimed to determine and compare the frequency, characteristics, and predictive factors of ADEs according to age in an adult population. A prospective seven-year cross-sectional study was conducted in a university hospital emergency department. Structured medication reviews and ADE detection were performed. Patient data and ADE characteristics were collected. Descriptive statistics and logistic regression were performed in two age groups: Group 1 (age < 65 years) and 2 (age ≥ 65 years). Among the 13,653 patients included, 18.4% in Group 1 and 22.6% in Group 2 experienced an ADE. Differences were identified in terms of the ADE type (more ADEs due to noncompliance in Group 1) and ADE symptoms (greater bleeding in Group 2). In the multivariable analysis, several specific predictive factors were identified, including kidney failure and antidiabetic drug use in Group 1 and inappropriate prescription and antithrombotic treatment in Group 2. Analysis by age provided a more refined vision of ADEs as we identified distinct profiles of iatrogenesis. These results will lead to a better detection of ADEs.

Keywords: adverse drug event; age factors; emergency department; epidemiology and detection; healthcare quality improvement; patient safety; pharmaceutical team.

Figure 1

Flowchart of the study population. ADE, adverse drug event; ADEsED: adverse drug events at emergency department (ADEsED); ED, emergency department. ADEsED study is registered on ClinicalTrials.gov (NCT03442010, accessed on 25 August 2022).

Figure 2

Lists of the top 5 medications most involved in ADEs and with the highest ADE rates. For medications most involved (a,b) data are presented as n (% of all medications involved in an ADE) for patients being less than 65 years (a) and more than 65 years (b), categorized by ATC class level 2. Medications ADE rates were determined by dividing the number of times a medication was involved in an ADE by the total number of prescriptions for that medication among included patients. ADE rates are presented as a percentage, for patients being less than 65 years (c) and more than 65 years (d), categorized by ATC class 2.