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June 18, 2014
Chronically Ill Children Have High Rates of Adverse
Drug Reactions Aurora, CO—Children with complex chronic conditions often take multiple medications, which puts them at higher risk of outpatient adverse drug events (ADEs). That’s according to a new study published recently in the journal Pediatrics. Noting that ADEs can have serious outcomes, the study, led by researchers from the Children’s Outcomes Research Program at the Children’s Hospital Colorado, sought to determine how often children with complex chronic conditions (CCCs) ended up at the ED because of drug reactions and what medications were most often implicated. The complex chronic conditions fell into several groups: neurologic issues (seizures, pain control, behavior/mood disorders), pulmonary issues (asthma, chronic lung disease, aspiration), gastrointestinal issues (gastrostomy tube, reflux, constipation), endocrine disturbances (adrenal insufficiency), and infectious issues (central line, catheter, or shunt infections). For the retrospective cohort study of ED visits by patients aged 0 to 18 years, ADEs were identified by external cause of injury codes, excluding cases with overdose, wrongful administration, self-harm, or diagnosis of malignancy. About half of 1% of 144 million ED visits were found to be associated with ADEs. A child having a complex condition was at higher risk for having to seek emergency treatment but not for inpatient admission. ADE-related visits were more likely on the weekends and in certain regional hospitals among female children of increasing age with private insurance and a complex condition. Among children with a CCC and an ADE, the neuromuscular CCC class accounted for the majority of visits (56%), followed by cardiovascular (17%), hematologic/immunologic (11%), and metabolic (10%) classes. After adjusting for age, gender, insurance status, weekday of visit, and regional location of the hospital, the study found that the presence of a CCC remained strongly associated with the likelihood of any ADE (odds ratio 4.76; 95% confidence interval 4.45– 5.10). Among CCC-related ADE visits, psychotropic medications were the suspected cause in 18% of cases, followed by unclassified medications (13%), antimicrobial agents (12%) and anticonvulsants (11%). Among non-CCC-related ADE visits, unclassified medications were the suspected causes in 39% of cases, followed by antimicrobial agents (29%), analgesics (5%) and vaccines (4%). Complex chronic conditions affected which drugs were most likely to cause an adverse reaction. Among psychotropic ADEs, for example, antipsychotics accounted for 41% of ADEs in CCC visits vs. 26% in non-CCC visits; psychostimulants, 8% CCC vs. 30% non-CCC; tranquilizers, 28% CCC vs. 14% non-CCC; and antidepressants, 8% CCC vs. 18% non-CCC. “ED visits associated with ADEs were more likely to occur for children with CCCs, and the implicated drugs differed, but ADE-related admissions were not differentially affected by CCC status,” the authors conclude.
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