Emergency department visits by adults for psychiatric medication adverse events

Lee M. Hampton, Matthew Daubresse, Hsien-Yen Chang, George Caleb Alexander, Daniel S. Budnitz

Research output: Contribution to journalArticle

Abstract

Importance In 2011, an estimated 26.8 million US adults used prescription medications for mental illness. Objective To estimate the numbers and rates of adverse drug event (ADE) emergency department (ED) visits involving psychiatric medications among US adults between January 1, 2009, and December 31, 2011. Design and Setting Descriptive analyses of active, nationally representative surveillance of ADE ED visits using the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance system and of drug prescribing during outpatient visits using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Participants Medical records from national probability samples of ED and outpatient visits by adults 19 years or older were reviewed and analyzed. Exposures Antidepressants, antipsychotics, lithium salts, sedatives and anxiolytics, and stimulants. Main Outcomes and Measures National estimates of ADE ED visits resulting from therapeutic psychiatric medication use and of psychiatric medication ADE ED visits per 10 000 outpatient visits at which psychiatric medications were prescribed. Results From 2009 through 2011, there were an estimated 89 094 (95%CI, 68 641-109 548) psychiatric medication ADE ED visits annually, with 19.3%(95%CI, 16.3%-22.2%) resulting in hospitalization and 49.4%(95%CI, 46.5%-52.4%) involving patients aged 19 to 44 years. Sedatives and anxiolytics, antidepressants, antipsychotics, lithium salts, and stimulants were implicated in an estimated 30 707 (95%CI, 23 406-38 008), 25 377 (95%CI, 19 051-31 704), 21 578 (95%CI, 16 599-26 557), 3620 (95%CI, 2311-4928), and 2779 (95%CI, 1764-3794) respective ADE ED visits annually. Antipsychotics and lithium salts were implicated in 11.7 (95%CI, 10.1-13.2) and 16.4 (95%CI, 13.0-19.9) ADE ED visits per 10 000 outpatient prescription visits, respectively, compared with 3.6 (95%CI, 3.2-4.1) for sedatives and anxiolytics, 2.9 (95%CI, 2.3-3.5) for stimulants, and 2.4 (95%CI, 2.1-2.7) for antidepressants. The commonly used sedative zolpidem tartrate was implicated in 11.5%(95%CI, 9.5%-13.4%) of all adult psychiatric medication ADE ED visits and in 21.0%(95%CI, 16.3%-25.7%) of visits involving adults 65 years or older, in both cases significantly more than any other psychiatric medication. Conclusions And Relevance Psychiatric medications are implicated in many ADEs treated in US EDs. Efforts to reduce ADEs should include adults of all ages but might prioritize medications causing high numbers and rates of ED visits.

Original languageEnglish (US)
Pages (from-to)1006-1014
Number of pages9
JournalJAMA Psychiatry
Volume71
Issue number9
DOIs
StatePublished - Sep 1 2014

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Drug-Related Side Effects and Adverse Reactions
Psychiatry
Hospital Emergency Service
Hypnotics and Sedatives
Anti-Anxiety Agents
Outpatients
Lithium
Antidepressive Agents
Antipsychotic Agents
Health Care Surveys
Salts
Prescriptions
Drugs
Emergency
Medication
Drug Prescriptions
Sampling Studies
Medical Records
Hospitalization
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Psychiatry and Mental health
  • Medicine(all)

Cite this

Emergency department visits by adults for psychiatric medication adverse events. / Hampton, Lee M.; Daubresse, Matthew; Chang, Hsien-Yen; Alexander, George Caleb; Budnitz, Daniel S.

In: JAMA Psychiatry, Vol. 71, No. 9, 01.09.2014, p. 1006-1014.

Research output: Contribution to journalArticle

Hampton, Lee M. ; Daubresse, Matthew ; Chang, Hsien-Yen ; Alexander, George Caleb ; Budnitz, Daniel S. / Emergency department visits by adults for psychiatric medication adverse events. In: JAMA Psychiatry. 2014 ; Vol. 71, No. 9. pp. 1006-1014.
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abstract = "Importance In 2011, an estimated 26.8 million US adults used prescription medications for mental illness. Objective To estimate the numbers and rates of adverse drug event (ADE) emergency department (ED) visits involving psychiatric medications among US adults between January 1, 2009, and December 31, 2011. Design and Setting Descriptive analyses of active, nationally representative surveillance of ADE ED visits using the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance system and of drug prescribing during outpatient visits using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Participants Medical records from national probability samples of ED and outpatient visits by adults 19 years or older were reviewed and analyzed. Exposures Antidepressants, antipsychotics, lithium salts, sedatives and anxiolytics, and stimulants. Main Outcomes and Measures National estimates of ADE ED visits resulting from therapeutic psychiatric medication use and of psychiatric medication ADE ED visits per 10 000 outpatient visits at which psychiatric medications were prescribed. Results From 2009 through 2011, there were an estimated 89 094 (95{\%}CI, 68 641-109 548) psychiatric medication ADE ED visits annually, with 19.3{\%}(95{\%}CI, 16.3{\%}-22.2{\%}) resulting in hospitalization and 49.4{\%}(95{\%}CI, 46.5{\%}-52.4{\%}) involving patients aged 19 to 44 years. Sedatives and anxiolytics, antidepressants, antipsychotics, lithium salts, and stimulants were implicated in an estimated 30 707 (95{\%}CI, 23 406-38 008), 25 377 (95{\%}CI, 19 051-31 704), 21 578 (95{\%}CI, 16 599-26 557), 3620 (95{\%}CI, 2311-4928), and 2779 (95{\%}CI, 1764-3794) respective ADE ED visits annually. Antipsychotics and lithium salts were implicated in 11.7 (95{\%}CI, 10.1-13.2) and 16.4 (95{\%}CI, 13.0-19.9) ADE ED visits per 10 000 outpatient prescription visits, respectively, compared with 3.6 (95{\%}CI, 3.2-4.1) for sedatives and anxiolytics, 2.9 (95{\%}CI, 2.3-3.5) for stimulants, and 2.4 (95{\%}CI, 2.1-2.7) for antidepressants. The commonly used sedative zolpidem tartrate was implicated in 11.5{\%}(95{\%}CI, 9.5{\%}-13.4{\%}) of all adult psychiatric medication ADE ED visits and in 21.0{\%}(95{\%}CI, 16.3{\%}-25.7{\%}) of visits involving adults 65 years or older, in both cases significantly more than any other psychiatric medication. Conclusions And Relevance Psychiatric medications are implicated in many ADEs treated in US EDs. Efforts to reduce ADEs should include adults of all ages but might prioritize medications causing high numbers and rates of ED visits.",
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N2 - Importance In 2011, an estimated 26.8 million US adults used prescription medications for mental illness. Objective To estimate the numbers and rates of adverse drug event (ADE) emergency department (ED) visits involving psychiatric medications among US adults between January 1, 2009, and December 31, 2011. Design and Setting Descriptive analyses of active, nationally representative surveillance of ADE ED visits using the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance system and of drug prescribing during outpatient visits using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Participants Medical records from national probability samples of ED and outpatient visits by adults 19 years or older were reviewed and analyzed. Exposures Antidepressants, antipsychotics, lithium salts, sedatives and anxiolytics, and stimulants. Main Outcomes and Measures National estimates of ADE ED visits resulting from therapeutic psychiatric medication use and of psychiatric medication ADE ED visits per 10 000 outpatient visits at which psychiatric medications were prescribed. Results From 2009 through 2011, there were an estimated 89 094 (95%CI, 68 641-109 548) psychiatric medication ADE ED visits annually, with 19.3%(95%CI, 16.3%-22.2%) resulting in hospitalization and 49.4%(95%CI, 46.5%-52.4%) involving patients aged 19 to 44 years. Sedatives and anxiolytics, antidepressants, antipsychotics, lithium salts, and stimulants were implicated in an estimated 30 707 (95%CI, 23 406-38 008), 25 377 (95%CI, 19 051-31 704), 21 578 (95%CI, 16 599-26 557), 3620 (95%CI, 2311-4928), and 2779 (95%CI, 1764-3794) respective ADE ED visits annually. Antipsychotics and lithium salts were implicated in 11.7 (95%CI, 10.1-13.2) and 16.4 (95%CI, 13.0-19.9) ADE ED visits per 10 000 outpatient prescription visits, respectively, compared with 3.6 (95%CI, 3.2-4.1) for sedatives and anxiolytics, 2.9 (95%CI, 2.3-3.5) for stimulants, and 2.4 (95%CI, 2.1-2.7) for antidepressants. The commonly used sedative zolpidem tartrate was implicated in 11.5%(95%CI, 9.5%-13.4%) of all adult psychiatric medication ADE ED visits and in 21.0%(95%CI, 16.3%-25.7%) of visits involving adults 65 years or older, in both cases significantly more than any other psychiatric medication. Conclusions And Relevance Psychiatric medications are implicated in many ADEs treated in US EDs. Efforts to reduce ADEs should include adults of all ages but might prioritize medications causing high numbers and rates of ED visits.

AB - Importance In 2011, an estimated 26.8 million US adults used prescription medications for mental illness. Objective To estimate the numbers and rates of adverse drug event (ADE) emergency department (ED) visits involving psychiatric medications among US adults between January 1, 2009, and December 31, 2011. Design and Setting Descriptive analyses of active, nationally representative surveillance of ADE ED visits using the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance system and of drug prescribing during outpatient visits using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Participants Medical records from national probability samples of ED and outpatient visits by adults 19 years or older were reviewed and analyzed. Exposures Antidepressants, antipsychotics, lithium salts, sedatives and anxiolytics, and stimulants. Main Outcomes and Measures National estimates of ADE ED visits resulting from therapeutic psychiatric medication use and of psychiatric medication ADE ED visits per 10 000 outpatient visits at which psychiatric medications were prescribed. Results From 2009 through 2011, there were an estimated 89 094 (95%CI, 68 641-109 548) psychiatric medication ADE ED visits annually, with 19.3%(95%CI, 16.3%-22.2%) resulting in hospitalization and 49.4%(95%CI, 46.5%-52.4%) involving patients aged 19 to 44 years. Sedatives and anxiolytics, antidepressants, antipsychotics, lithium salts, and stimulants were implicated in an estimated 30 707 (95%CI, 23 406-38 008), 25 377 (95%CI, 19 051-31 704), 21 578 (95%CI, 16 599-26 557), 3620 (95%CI, 2311-4928), and 2779 (95%CI, 1764-3794) respective ADE ED visits annually. Antipsychotics and lithium salts were implicated in 11.7 (95%CI, 10.1-13.2) and 16.4 (95%CI, 13.0-19.9) ADE ED visits per 10 000 outpatient prescription visits, respectively, compared with 3.6 (95%CI, 3.2-4.1) for sedatives and anxiolytics, 2.9 (95%CI, 2.3-3.5) for stimulants, and 2.4 (95%CI, 2.1-2.7) for antidepressants. The commonly used sedative zolpidem tartrate was implicated in 11.5%(95%CI, 9.5%-13.4%) of all adult psychiatric medication ADE ED visits and in 21.0%(95%CI, 16.3%-25.7%) of visits involving adults 65 years or older, in both cases significantly more than any other psychiatric medication. Conclusions And Relevance Psychiatric medications are implicated in many ADEs treated in US EDs. Efforts to reduce ADEs should include adults of all ages but might prioritize medications causing high numbers and rates of ED visits.

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