RESEARCH · July 09, 2014
TAKE-HOME MESSAGE
- This study used data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance system to estimate the number of adverse drug events (ADEs) involving psychiatric medications among US adults resulting in emergency department (ED) visits. Annually from 2009 to 2011, there were nearly 90,000 ED visits due to psychiatric ADEs, with 19% requiring hospitalization. The study also found that, per 10,000 outpatient prescription visits, antipsychotics were implicated in 11.7, lithium salts in 16.4, sedatives and anxiolytics in 3.6, stimulants in 2.9, and antidepressants in 2.4. Zolpidem tartrate accounted for about 11.5% of all adult psychiatric ADE ED visits, which was significantly higher than any other psychiatric medication.
- EDs treat many ADEs associated with psychiatric medication. Efforts to reduce ADEs should prioritize those that account for high numbers of ED visits.
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.
JAMA Psychiatry
Emergency Department Visits by Adults for Psychiatric Medication Adverse Events