Most emergency hospitalizations for recognized adverse drug events in older adults resulted from a few commonly used medications, and relatively few resulted from medications typically designated as high-risk or inappropriate. Improved management of antithrombotic and antidiabetic drugs has the potential to reduce hospitalizations for adverse drug events in older adults.

Adverse drug events among outpatients that lead to emergency department visits are an important cause of morbidity in the United States, particularly among individuals aged 65 years or older. Ongoing, population-based surveillance can help monitor these events and target prevention strategies.

A national epidemic of drug poisoning deaths began in the 1990s. Prescriptions for opioid analgesics also increased in this time frame and may have inadvertently contributed to the increases in drug poisoning deaths.

IMPORTANCE The Patient Protection and Affordable Care Act of 2010 brought attention to adverse drug events in national patient safety efforts. Updated, detailed, nationally representative data describing adverse drug events can help focus these efforts. OBJECTIVE To describe the characteristics of emergency department (ED) visits for adverse drug events in the United States in 2013-2014 and describe changes in ED visits for adverse drug events since 2005-2006. DESIGN, SETTING, AND PARTICIPANTS Active, nationally representative, public health surveillance in 58 EDs located in the United States and participating in the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project. EXPOSURES Drugs implicated in ED visits. MAIN OUTCOMES AND MEASURES National weighted estimates of ED visits and subsequent hospitalizations for adverse drug events. RESULTS Based on data from 42 585 cases, an estimated 4.0 (95% CI, 3.1-5.0) ED visits for adverse drug events occurred per 1000 individuals annually in 2013 and 2014 and 27.3% (95% CI, 22.2%-32.4%) of ED visits for adverse drug events resulted in hospitalization. An estimated 34.5% (95% CI, 30.3%-38.8%) of ED visits for adverse drug events occurred among adults aged 65 years or older in 2013-2014 compared with an estimated 25.6% (95% CI, 21.1%-30.0%) in 2005-2006; older adults experienced the highest hospitalization rates (43.6%; 95% CI, 36.6%-50.5%). Anticoagulants, antibiotics, and diabetes agents were implicated in an estimated 46.9% (95% CI, 44.2%-49.7%) of ED visits for adverse drug events, which included clinically significant adverse events, such as hemorrhage (anticoagulants), moderate to severe allergic reactions (antibiotics), and hypoglycemia with moderate to severe neurological effects (diabetes agents). Since 2005-2006, the proportions of ED visits for adverse drug events from anticoagulants and diabetes agents have increased, whereas the proportion from antibiotics has decreased. Among children aged 5 years or younger, antibiotics were the most common drug class implicated (56.4%; 95% CI, 51.8-61.0%). Among children and adolescents aged 6 to 19 years, antibiotics also were the most common drug class implicated (31.8%; 95% CI, 28.7%-34.9%) in ED visits for adverse drug events, followed by antipsychotics (4.5%; 95% CI, 3.3-5.6%). Among older adults (aged ≥65 years), 3 drug classes (anticoagulants, diabetes agents, and opioid analgesics) were implicated in an estimated 59.9% (95% CI, 56.8%-62.9%) of ED visits for adverse drug events; 4 anticoagulants (warfarin, rivaroxaban, dabigatran, and enoxaparin) and 5 diabetes agents (insulin and 4 oral agents) were among the 15 most common drugs implicated. Medications to always avoid in older adults according to Beers criteria were implicated in 1.8% (95% CI, 1.5%-2.1%) of ED visits for adverse drug events. CONCLUSIONS AND RELEVANCE The prevalence of emergency department visits for adverse drug events in the United States was estimated to be 4 per 1000 individuals in 2013 an...

Compared with other medications, Beers criteria medications caused low numbers of and few risks for emergency department visits for adverse events. Performance measures and interventions targeting warfarin, insulin, and digoxin use could prevent more emergency department visits for adverse events.

Antibiotic-associated adverse events lead to many ED visits, and allergic reactions are the most common events. Minimizing unnecessary antibiotic use by even a small percentage could significantly reduce the immediate and direct risks of drug-related adverse events in individual patients.

Background: Dietary supplements, such as herbals/complementary nutritionals and micronutrients (vitamins/minerals), are commonly used in the U.S., yet national data on adverse effects are limited. Methods: We used a nationally representative stratified probability sample of 63 emergency departments (2004–2013) to describe U.S. emergency department visits for dietary supplement adverse events. Results: Based on 3,667 cases, we estimated that 23,005 (95% confidence interval [CI], 18,611–27,398) emergency department visits, resulting in 2,154 (CI, 1,342–2,967) hospitalizations, were attributed to adverse events from supplements annually. Emergency department visits for supplement adverse events commonly involved young adults aged 20–34 years (28.0%; CI, 25.1%−30.8%) and unsupervised children (21.2%; CI, 18.4%−24.0%). Excluding unsupervised child ingestions, 65.9% (CI, 63.2%−68.5%) of emergency department visits for single-supplement adverse events involved herbals/complementary nutritionals; 31.8% (CI, 29.2%−34.3%) involved micronutrients. Herbal/complementary nutritional products for weight loss (25.5%; CI, 23.1%−27.9%) and increased energy (10.0%; CI, 8.0%−11.9%) were commonly implicated. These weight loss or energy products caused 71.8% (CI, 67.6%−76.1%) of supplement adverse events involving palpitations, chest pain, and/or tachycardia, and 58.0% (CI, 52.2%−63.7%) involved persons aged 20–34 years. Among adults aged ≥65 years, choking or pill-induced dysphagia/globus caused 37.6% (CI, 29.1%−46.2%) of all emergency department visits for supplement adverse events; micronutrients were implicated in 83.1% (CI, 73.3%−92.9%) of these visits. Conclusions: Over 20,000 emergency departments visits in the US annually are attributed to dietary supplement adverse events; these commonly involve cardiovascular manifestations from weight loss or energy products in younger adults, micronutrient ingestions by unsupervised children, and swallowing problems, usually from micronutrients, in older adults.

data-tracker/#variant-proportions Vaccine type/Period † Aggregate weekly count of residents No. of cases Vaccine effectiveness, % (95% CI) p-value** Unadjusted § Adjusted ¶ Any mRNA vaccine