Journal Reviews

Hohl CM, Dankoff J, Colacone A, et al. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med 2001; 38:666-671.

Adverse drug-related events are a significant cause of ED visits in the elderly, and potential adverse drug interactions are common in medication regiments of elderly patients who visit the ED, according to researchers from Sir Mortimer B. Davis-Jewish General Hospital and McGill University in Montreal. Here were key findings:

• The most frequently implicated classes of medications were nonsteroidal anti-inflammatory drugs, antibiotics, anticoagulants, diuretics, hypoglycemics, beta-blockers, calcium-channel blockers, and chemotherapeutic agents.

• Of 283 patients 65 years of age and older, 257 (90.8%) were taking one or more medications, with an average of 4.2 drugs per patient. In this group, adverse drug-related events accounted for 10.6% of the ED visits.

• 31% of patients in the group had at least one potential adverse drug interaction in their medication list.

• Of patients who presented because of an adverse drug-related event, half had at least one additional unrelated potential adverse drug interaction in their medication list.

Given the alarming rates of adverse drug-related events the researchers found, they recommend that medication regiments of incoming high-risk patients should be systematically screened in the ED. "The ED is a unique place to recognize these problems and intervene, given the rapid access to laboratory information, medical consultants, and expert pharmacologic information," they wrote.

Scribano PV, Lerer T, Kennedy D, et al. Provider adherence to a clinical practice guideline for acute asthma in a pediatric emergency department. Acad Emerg Med 2001; 8:1147-1152.

Clinical practice guidelines are an efficient management and treatment approach for acute exacerbations of childhood asthma, says this study from the Connecticut Children’s Medical Center in Hartford.

Of 369 children who presented to the ED, 24% had mild exacerbations, 59% had moderate exacerbations, and 17% had severe exacerbations. Sixty-eight percent of the patients were managed with complete adherence to the clinical practice guidelines based on recommendations from the Bethesda, MD-based National Asthma Education and Prevention Program.

"We found significantly improved adherence during the busiest shift (evening); however, our staffing is upgraded during that shift to accommodate the increased volume," the authors wrote.