Budnitz DS, Shehab N, Kegler SR, et al. Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med. 2007;147(11):755-765

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Annals of internal medicine (Impact Factor: 17.81). 01/2008; 147(11):755-65.
Source: PubMed


The Beers criteria identify inappropriate use of medications in older adults. The number of and risk for adverse events from these medications are unknown.
To estimate the number of and risk for emergency department visits for adverse events involving Beers criteria medications compared with other medications.
Nationally representative, public health surveillance of adverse drug events and a cross-sectional survey of outpatient medical visits.
National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance System, 2004-2005; National Ambulatory Medical Care Survey, 2004; and National Hospital Ambulatory Medical Care Survey, 2004.
Persons 65 years of age or older seeking emergency department and outpatient care.
Estimated number of and risks for emergency department visits for adverse drug events involving Beers criteria medications and other medications.
Among U.S. patients 65 years of age or older, an estimated 177,504 emergency department visits (95% CI, 100,155 to 254,854 visits) for adverse drug events occurred both years. An estimated 3.6% (CI, 2.8% to 4.5%) of these visits were for adverse events medications considered to be always potentially inappropriate, according to the Beers criteria, and 33.3% (CI, 27.8% to 38.7%) of visits were for adverse events from 3 other medications (warfarin [17.3%], insulin [13.0%], and digoxin [3.2%]). Accounting for outpatient prescription frequency, the risk for emergency department visits for adverse events due to these 3 medications was 35 times (CI, 9.6 to 61) greater than that for medications considered to be always potentially inappropriate.
Adverse events were identified only in emergency departments.
Compared with other medications, Beers criteria medications caused low numbers of and few risks for emergency department visits for adverse events. Performance measures and interventions targeting warfarin, insulin, and digoxin use could prevent more emergency department visits for adverse events.

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Available from: Budnitz Daniel, Jan 30, 2014
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    ABSTRACT: Background: The Gamma-glutamyl carboxylase (GGCX) gene, as with Vitamin K Epoxide Reductase Complex Subunit 1 (VKORC1), CytochromeP450 Complex Subunit 14 F2 (CYP4F2) and CytochromeP450 Complex Subunit2C9 (CYP2C9), is a candidate predictor for appropriate maintenance warfarin dose. However, the association between GGCX gene polymorphisms and warfarin dose requirement is still controversial. To quantify the influence of GGCX polymorphisms on warfarin dose requirements, we performed a systematic review and meta-analysis. Methods: According to PRISRM statement (Preferred reporting items for systematic reviews and meta-analyses), a comprehensive literature search was undertaken through August 2014 looking for eligible studies in Embase, Pubmed,Web of Science and the Cochrane Library. The impact of GGCX polymorphisms on mean daily warfarin dose (MDWD) was counted by means of Z test. RevMan 5.2.7 software (developed by the Cochrane Collaboration) was applied to analyze the relationship between GGCX gene polymorphisms and warfarin dose requirements. Results: Nineteen articles including 21 studies with a total of 6957 patients were included in the meta-analysis. Among three investigated single nucleotide polymorphisms (SNPs), rs11676382 showed higher CC genotype frequencies in Asian than those in Caucasian (97.7% vs. 86.9%); patients who were "G carriers" (that is, carried the GGCX rs11676382 CG or GG genotypes) required 27% lower warfarin dose than CC genotype [95%Confidence Interval (CI)=17%-37%, P=0.000, I(2)%=82.0 and PQ=0.000], moreover, stratified analysis by ethnicity showed similar results in Caucasian (23% lower, 95%CI=12%-33%), but not in Asian. With respect to genetic variation of rs699664 and rs121714145 SNPs, no significant impact on warfarin dose requirements were demonstrated. Conclusions: This meta-analysis suggested that GGCX rs11676382 polymorphism may be one of factors affecting the dose of warfarin requirement, and the effects are different in different ethnicities. Further studies about this topic in different ethnicities with larger samples are expected to be conducted to validate our results.
    Thrombosis Research 02/2015; 167(4). DOI:10.1016/j.thromres.2015.01.029 · 2.45 Impact Factor
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    • "In general, older patients may require multiple medications, and thus are more likely to receive PIMs which are associated with an increased rate of ADEs [9] [33]. In our study, 6.8% (20/295) of ADEs met the Beers criteria [34] (a consensus-based list of medication identified as potentially inappropriate for use in older adults), which was lower than the 8.8% reported in a U.S. crosssectional study [35]. The discrepancy can be due to differences in the study design, sample size, and identification of ADE cases. "
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    European Journal of Internal Medicine 11/2013; 25(1). DOI:10.1016/j.ejim.2013.10.006 · 2.89 Impact Factor
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    • "thiazide-diuretics [38]. This discrepancy which was also observed in other studies [51-53], could be due to a different prescribing pattern or differing opinions about inappropriateness between the US and Europe [54,55]. Another publication compared seven explicit criteria of drug inappropriateness in elderly patients from different countries, including the Beers criteria [56]. "
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    ABSTRACT: Since drug-related emergency department (ED) visits are common among older adults, the objectives of our study were to identify the frequency of drug-related problems (DRPs) among patients presenting to the ED with non-specific complaints (NSC), such as generalized weakness and to evaluate responsible drug classes. Delayed type cross-sectional diagnostic study with a prospective 30 day follow-up in the ED of the University Hospital Basel, Switzerland. From May 2007 until April 2009, all non-trauma patients presenting to the ED with an Emergency Severity Index (ESI) of 2 or 3 were screened and included, if they presented with non-specific complaints. After having obtained complete 30-day follow-up, two outcome assessors reviewed all available information, judged whether the initial presentation was a DRP and compared their judgment with the initial ED diagnosis. Acute morbidity (“serious condition”) was allocated to individual cases according to predefined criteria. The study population consisted of 633 patients with NSC. Median age was 81 years (IQR 72/87), and the mean Charlson comorbidity index was 2.5 (IQR 1/4). DRPs were identified in 77 of the 633 cases (12.2%). At the initial assessment, only 40% of the DRPs were correctly identified. 64 of the 77 identified DRPs (83%) fulfilled the criteria “serious condition”. Polypharmacy and certain drug classes (thiazides, antidepressants, benzodiazepines, anticonvulsants) were associated with DRPs. Elderly patients with non-specific complaints need to be screened systematically for drug-related problems. Trial Registration NCT00920491
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 03/2013; 21(1):15. DOI:10.1186/1757-7241-21-15 · 2.03 Impact Factor
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