Personalising drug safety—results from the multi-centre prospective observational study on Adverse Drug Reactions in Emergency Departments (ADRED)

Just, Katja S; Dormann, Harald; Böhme, Miriam; Schurig, Marlen; Schneider, Katharina; Steffens, Michael; Dunow, Sandra; Plank-Kiegele, Bettina; Ettrich, Kristin; Seufferlein, Thomas; Gräff, Ingo; Igel, Svitlana; Schricker, Severin; Jaeger, Simon U.; Schwab, Matthias; Stingl, Julia

doi:10.1007/s00228-019-02797-9

Cited by 19 publications

(31 citation statements)

References 43 publications

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“…In median, patients were 73 years and used 7 medications concurrently at the same time. While drugs used in these polymedicated patients were not always suspected to be causative for the ADR, psychotropic drugs overrepresented in the group of suspected drugs compared to the concomitant drugs [8].…”

Section: Discussionmentioning

confidence: 87%

Prevalence of Psychotropic Drugs in Cases of Severe Adverse Drug Reactions Leading to Unplanned Emergency Visits in General Hospitals

et al. 2020

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Introduction The prevalence of psychotropic drug use in our society is increasing especially in older adults, thereby provoking severe adverse drug reactions (ADR). To identify specific patient risk profiles associated with psychotropic drug use in the situation of polymedication. Methods Cases of ADRs in general emergency departments (ED) collected within the multi-center prospective observational study (ADRED) were analyzed (n=2215). We compared cases with use of psychotropic drugs and without concerning their clinical presentation at the ED. Results A third of patients (n=731, 33%) presenting to the ED with an ADR took at least 1 psychotropic drug. Patients with psychotropic drug use tended to be older, more often female, and took a higher number of drugs (all p<0.001). The frequency of falls was almost 3 times higher than compared to the non-psychotropic drug group (10.5 vs. 3.9%, p<0.001), and similar syncope was also more often seen in the psychotropic drug users (8.8 vs. 5.5%, p=0.004). The use of psychotropic drugs increased the risk for falls by a factor of 2.82 (OR, 95% CI (1.90–4.18)), when adjusting for gender, age, numbers of pre-existing diseases, and drugs, respectively. Discussion The association of psychotropic drug use with fall and syncope in combination with polymedication and older age leads to the suspicion that psychotropic drugs might be potentially harmful in specific risk populations such as older adults. It may lead us to thoroughly weigh the benefit against risk in a patient-oriented way, leading to an integrative personalized therapy approach.

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Section: Discussionmentioning

confidence: 87%

Prevalence of Psychotropic Drugs in Cases of Severe Adverse Drug Reactions Leading to Unplanned Emergency Visits in General Hospitals

et al. 2020

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“…This might be a consequence of medication as antineoplastic and immunomodulating agents being commonly taken in this cohort of ADRs 9 and neoplasms more often underlying diseases of younger adults.…”

Section: Discussionmentioning

confidence: 97%

“…Older adults take more drugs, have more comorbidities, more serious ADRs, tend to stay longer in hospitals, and have a higher risk of mortality compared to younger individuals presenting with side effects in an emergency. 6,9 This challenge might be most prominent in the context of older multimorbid patients. 6,15 Older adults have been reported to present to the ED with unspecific symptoms as a response to a drug.…”

Section: While Many Data Exist About Prevalence and Drugs Involved Inmentioning

confidence: 99%

“…6 Further details on enrolment and study design are published elsewhere. 6,9 In brief, inclusion criteria were adult patients, presenting with symptoms that were seen in a possible, probable or certain relationship to a drug (ADR) according to the World Health Organization-Uppsala Monitoring Centre system for causality assessment by a trained physician or a pharmacist. 22 Those personnel were experienced in emergency care, clinical pharmacy and drug safety, respectively.…”

Section: Study Populationmentioning

confidence: 99%

“…Adverse drug reactions (ADRs) are common, can lead to emergency department (ED) visits, and hospital admissions. [1][2][3][4][5][6][7][8][9] Thereby ADRs can generate relevant health care costs. 1,2 Moreover, ADRs can be harmful and followed by complications leading to morbidity or even death.…”

Section: Introductionmentioning

confidence: 99%

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The phenotype of adverse drug effects: Do emergency visits due to adverse drug reactions look different in older people? Results from the ADRED study

Just

Dormann

Schurig

et al. 2020

Brit J Clinical Pharma

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Older patients in particular suffer from adverse drug reactions (ADR) when presenting in the emergency department. We aimed to characterise the phenotype of those ADRs, to be able to recognise an ADR in older patients. Methods: Cases of ADRs in emergency departments collected within the multicentre prospective observational study (ADRED) were analysed (n = 2215). We analysed ADR-associated diagnoses, symptoms and their risk profiles. We present frequencies and odds ratios (OR) with 95% confidence intervals for adults (18-64 years) compared to older adults (≥65 years; young-old 65-79, old-old ≥80 years) and regression coefficients (B) for each year of age. Results: Most prominent differences were seen for drug-associated confusion, dehydration, and bradycardia (OR 6.70 [1.59-28.27], B .054; OR 6.02 [2.41-15.03], B .081, and 4.82 [2.21-10.54], B .040), more likely seen in older adults. Bleedings were reported in all age groups, but gastrointestinal bleedings occurred with more than doubled chance in older adults (OR 2.46 [1.77-3.41], B .030), likewise did other bleedings such as haemorrhage from respiratory passages (OR 2.89 [1.37-6.11], B.036). Falls were more likely in older adults (OR 2.84 [1.77-4.53], B .030), while dizziness was frequent in both age groups. Conclusion: Our data point to differences in symptoms of ADRs between adults and older individuals, with dangerous drug-associated phenomena in the older adult such as bleedings or falls. Physicians should consider drug-associated origins of symptoms in older adults with an increased risk for serious health problems.

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Adverse drug reactions as cause of nonspecific symptoms in patients in the emergency department

Hellinger,

Remane,

Bertsche

et al. 2023

Anaesthesiologie

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Personalising drug safety—results from the multi-centre prospective observational study on Adverse Drug Reactions in Emergency Departments (ADRED)

Cited by 19 publications

References 43 publications

Prevalence of Psychotropic Drugs in Cases of Severe Adverse Drug Reactions Leading to Unplanned Emergency Visits in General Hospitals

Prevalence of Psychotropic Drugs in Cases of Severe Adverse Drug Reactions Leading to Unplanned Emergency Visits in General Hospitals

The phenotype of adverse drug effects: Do emergency visits due to adverse drug reactions look different in older people? Results from the ADRED study

Adverse drug reactions as cause of nonspecific symptoms in patients in the emergency department

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