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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急诊就诊原因引起的不良药物事件的特征和可预防性：一项为期1年的前瞻性观察研究。

背景技术不良药品事件（ADEs）是急诊科（ED）拜访的重要原因，对医疗资源的利用具有重大影响。在西西里岛（意大利）进行了为期一年的多中心观察性研究，目的是描述四个ED中报告的ADE的频率，严重性和可预防性。方法每位ED的两名受过培训的监测员通过对患者或其护理人员进行系统性访谈并进行额外的记录审查，在2013年6月1日至2014年5月31日之间支持临床医生确定ED入院患者的ADE。一个研究小组分析了每例疑似ADE，以使用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。估计具有95％置信区间（CI）的绝对频率和百分比频率以及四分位数间距（IQR）的中值。使用逻辑回归模型评估严重且肯定可以预防的ADE的独立预测因子。结果在16,963例ED访视中，有575例（3.4％）与ADE相关，其中15.1％导致了住院。ADE被分类为45.9％的可能性，51.7％的可能性和2.4％的可能性。此外，ADEs被认为肯定可以预防的占12.3％，可能可以预防的占58.4％，而不能预防的占29.2％。混合疗法影响了发生严重的，肯定可以预防的ADE的风险。虽然年龄较大，但仅是严重事件的独立预测因子。最常见的牵连药物类别是抗生素（34。4％）和抗炎药（22.6％）。由精神病药物和抗癫痫药引起的ADE分别可预防62.7和54.5％的病例。变应性反应（64％）是与ADE相关的ED访视的最常见原因，其次是神经学影响（10.2％），分别导致1.9％和37.3％的病例可预防。结论ADE是ED访视的常见原因。常用的抗生素和抗炎药应谨慎处理，因为它们广泛参与轻度至重度ADEs。混合疗法与严重的以及肯定可以预防的ADEs的发生有关，而老年仅与严重的事件有关。需要使卫生专业人员对药物监测计划更加敏感。分别占5％。变应性反应（64％）是与ADE相关的ED访视的最常见原因，其次是神经学影响（10.2％），分别导致1.9％和37.3％的病例可预防。结论ADE是ED访视的常见原因。常用的抗生素和抗炎药应谨慎处理，因为它们广泛参与轻度至重度ADEs。混合疗法与严重的以及肯定可以预防的ADEs的发生有关，而老年仅与严重的事件有关。需要使卫生专业人员对药物监测计划更加敏感。分别占5％。变应性反应（64％）是与ADE相关的ED访视的最常见原因，其次是神经学影响（10.2％），分别导致1.9％和37.3％的病例可预防。结论ADE是ED访视的常见原因。常用的抗生素和抗炎药应谨慎处理，因为它们广泛参与轻度至重度ADEs。混合疗法与严重的以及肯定可以预防的ADEs的发生有关，而老年仅与严重的事件有关。需要使卫生专业人员对药物监测计划更加敏感。结论ADE是ED访视的常见原因。常用的抗生素和抗炎药应谨慎处理，因为它们广泛参与轻度至重度ADEs。混合疗法与严重的以及肯定可以预防的ADEs的发生有关，而老年仅与严重的事件有关。需要使卫生专业人员对药物监测计划更加敏感。结论ADE是ED访视的常见原因。常用的抗生素和抗炎药应谨慎处理，因为它们广泛参与轻度至重度ADEs。混合疗法与严重的以及肯定可以预防的ADEs的发生有关，而老年仅与严重的事件有关。需要使卫生专业人员对药物监测计划更加敏感。