BACKGROUND Adverse drug events (ADEs) are a significant cause of emergency department (ED) visits, with a major impact on healthcare resource utilization. A multicentre observational study, aimed to describe frequency, seriousness and preventability of ADEs reported in four EDs, was performed in Sicily (Italy) over a 1-year period. METHODS Two trained monitors for each ED supported clinicians in identifying ADEs of patients admitted to EDs between June 1st, 2013 and May 31st, 2014 through a systematic interview of patients or their caregivers and with an additional record review. A research team analyzed each case of suspected ADE, to make a causality assessment applying the Naranjo algorithm and a preventability assessment using Schumock and Thornton criteria. Absolute and percentage frequencies with 95% confidence interval (CI) and medians with interquartile ranges (IQR) were estimated. Logistic regression models were used to evaluate independent predictors of serious and certainly preventable ADEs. RESULTS Out of 16,963 ED visits, 575 (3.4%) were associated to ADEs, of which 15.1% resulted in hospitalization. ADEs were classified as probable in 45.9%, possible in 51.7% and definite in 2.4% of the cases. Moreover, ADEs were considered certainly preventable in 12.3%, probably preventable in 58.4%, and not preventable in 29.2% of the cases. Polytherapy influenced the risk to experience a serious, as well as a certainly preventable ADE. Whilst, older age resulted an independent predictor only of serious events. The most common implicated drug classes were antibiotics (34.4%) and anti-inflammatory drugs (22.6%). ADEs due to psycholeptics and antiepileptics resulted preventable in 62.7 and 54.5% of the cases, respectively. Allergic reactions (64%) were the most frequent cause of ADE-related ED visits, followed by neurological effects (10.2%) that resulted preventable in 1.9 and 37.3% of the cases, respectively. CONCLUSION ADEs are a frequent cause of ED visits. The commonly used antibiotics and anti-inflammatory drugs should be carefully managed, as they are widely involved in mild to severe ADEs. Polytherapy is associated with the occurrence of serious, as well as certainly preventable ADEs, while older age only with serious events. A greater sensitivity to drug monitoring programs among health professionals is needed.

中文翻译：

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作为急诊就诊原因的药物不良事件的特征和可预防性：一项为期一年的前瞻性观察研究。


背景药物不良事件（ADE）是急诊科（ED）就诊的一个重要原因，对医疗资源利用产生重大影响。在意大利西西里岛进行了一项为期一年的多中心观察性研究，旨在描述四个急诊室报告的不良事件的频率、严重性和可预防性。方法 每个急诊室都有两名训练有素的监测员，通过对患者或其护理人员进行系统访谈并进行额外的记录审查，支持临床医生识别 2013 年 6 月 1 日至 2014 年 5 月 31 日期间入住急诊室的患者的 ADE。研究小组分析了每个可疑 ADE 病例，应用 Naranjo 算法进行因果关系评估，并使用 Schumock 和 Thornton 标准进行可预防性评估。估计了 95% 置信区间 (CI) 的绝对频率和百分比频率以及四分位数范围 (IQR) 的中位数。逻辑回归模型用于评估严重且肯定可预防的 ADE 的独立预测因素。结果 在 16,963 例急诊就诊中，575 例 (3.4%) 与 ADE 相关，其中 15.1% 导致住院治疗。 45.9% 的 ADE 被分类为可能发生，51.7% 的病例被分类为可能发生，2.4% 的病例被分类为确定发生。此外，12.3% 的 ADE 被认为肯定可以预防，58.4% 的病例可能可以预防，29.2% 的病例不可预防。综合治疗会影响发生严重且当然可以预防的 ADE 的风险。然而，年龄较大仅是严重事件的独立预测因素。最常见的相关药物类别是抗生素（34.4%）和抗炎药（22.6%）。精神抑制药和抗癫痫药引起的 ADE 分别在 62.7% 和 54.5% 的病例中是可以预防的。 过敏反应 (64%) 是 ADE 相关急诊就诊的最常见原因，其次是神经系统影响 (10.2%)，分别有 1.9% 和 37.3% 的病例是可以预防的。结论 ADE 是急诊就诊的常见原因。常用的抗生素和抗炎药广泛涉及轻度至重度 ADE，因此应谨慎管理。多重治疗与严重且当然可以预防的 ADE 的发生有关，而年龄较大则仅与严重事件有关。卫生专业人员需要对药物监测计划更加敏感。