Dataset Information

U.S. Emergency Department Visits Resulting From Nonmedical Use of Pharmaceuticals, 2016.

ABSTRACT: INTRODUCTION:National data on morbidity from nonmedical use of pharmaceuticals are limited. This study used nationally representative, public health surveillance data to characterize U.S. emergency department visits for acute harms from nonmedical use of pharmaceuticals and to guide prevention efforts. METHODS:Data collected in 2016 from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project were analyzed in 2018 to calculate national estimates of emergency department visits for harms from nonmedical use of pharmaceuticals. RESULTS:Based on 5,130 surveillance cases, there were an estimated 358,247 emergency department visits (95% CI=280,675, 435,819) in 2016 for harms from nonmedical use of pharmaceuticals and 41.1% resulted in hospitalization (95% CI=32.3%, 49.8%). One half (50.9%, 95% CI=46.6%, 55.3%) of estimated visits involved patients aged ?34 years; more than one half of estimated visits also involved non-pharmaceutical substances (52.9%, 95% CI=49.7%, 56.1%), including illicit drugs in 34.1% (95% CI=30.9%, 37.2%) and alcohol in 21.8% (95% CI=19.8%, 23.9%). Overall, benzodiazepines were implicated in 46.9% (95% CI=42.5%, 51.2%) of estimated emergency department visits for nonmedical use of pharmaceuticals but were the only substance implicated in just 6.5% (95% CI=5.1%, 7.9%). Prescription opioids were implicated in 36.2% (95% CI=30.8%, 41.7%) of estimated emergency department visits and were the only substance implicated in 11.3% (95% CI=8.6%, 14.0%). CONCLUSIONS:Although prescription opioids or benzodiazepines are frequently implicated in emergency department visits for nonmedical use, because other substances and additional pharmaceuticals are most often involved, prescribing clinicians should consider implementing specific screening to address polysubstance use and, when warranted, treatment interventions.

SUBMITTER: Geller AI

PROVIDER: S-EPMC6475457 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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U.S. Emergency Department Visits Resulting From Nonmedical Use of Pharmaceuticals, 2016.

Geller Andrew I AI Dowell Deborah D Lovegrove Maribeth C MC McAninch Jana K JK Goring Sandra K SK Rose Kathleen O KO Weidle Nina J NJ Budnitz Daniel S DS

American journal of preventive medicine 20190306 5

<h4>Introduction</h4>National data on morbidity from nonmedical use of pharmaceuticals are limited. This study used nationally representative, public health surveillance data to characterize U.S. emergency department visits for acute harms from nonmedical use of pharmaceuticals and to guide prevention efforts.<h4>Methods</h4>Data collected in 2016 from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project were analyzed in 2018 to calculate nationa ...[more]

PMID: 30851991

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Project description:Background and objectivesIn 2011, there were approximately 131 million visits to an emergency department in the United States. Emergency department visits have increased over time, far outpacing growth of the general population. There is a paucity of data evaluating emergency department visits among kidney transplant recipients. We sought to evaluate the incidence and risk factors for emergency department visits after initial hospital discharge after transplantation in the United States.Design, setting, participants, & measurementsWe identified 10,533 kidney transplant recipients from California, New York, and Florida between 2009 and 2012 using the State Inpatient and Emergency Department Databases included in the Healthcare Cost and Utilization Project. We used multivariable Poisson and Cox proportional hazard models to evaluate adjusted incidence rates and time to emergency department visits after transplantation.ResultsThere were 17,575 emergency department visits over 13,845 follow-up years (overall rate =126.9/100 patient-years; 95% confidence interval, 125.1 to 128.8). The cumulative incidences of emergency department visits at 1, 12, and 24 months were 12%, 40%, and 57%, respectively, with median time =19 months; 48% of emergency department visits led to hospital admission. Risk factors for higher emergency department rates included younger age, women, black and Hispanic race/ethnicity, public insurance, depression, diabetes, peripheral vascular disease, and emergency department use before transplant. There was wide variation in emergency department visits by individual transplant center (10th percentile =70.0/100 patient-years; median =124.6/100 patient-years; and 90th percentile =187.4/100 patient-years).ConclusionsThe majority of kidney transplant recipients will visit an emergency department in the first 2 years post-transplantation, with significant variation by patient characteristics and individual centers. As such, coordination of care through the emergency department is a critical component of post-transplant management, and specific acumen of transplant-related care is needed among emergency department providers. Additional research assessing best processes of care for post-transplant management and health care expenditures and outcomes associated with emergency department visits for transplant recipients are warranted.

Project description:Short-term exposure to ambient fine particulate matter (PM2.5) concentrations has been associated with increased mortality and morbidity. Determining which sources of PM2.5 are most toxic can help guide targeted reduction of PM2.5. However, conducting multicity epidemiologic studies of sources is difficult because source-specific PM2.5 is not directly measured, and source chemical compositions can vary between cities.We determined how the chemical composition of primary ambient PM2.5 sources varies across cities. We estimated associations between source-specific PM2.5 and respiratory disease emergency department (ED) visits and examined between-city heterogeneity in estimated associations.We used source apportionment to estimate daily concentrations of primary source-specific PM2.5 for four U.S. cities. For sources with similar chemical compositions between cities, we applied Poisson time-series regression models to estimate associations between source-specific PM2.5 and respiratory disease ED visits.We found that PM2.5 from biomass burning, diesel vehicle, gasoline vehicle, and dust sources was similar in chemical composition between cities, but PM2.5 from coal combustion and metal sources varied across cities. We found some evidence of positive associations of respiratory disease ED visits with biomass burning PM2.5; associations with diesel and gasoline PM2.5 were frequently imprecise or consistent with the null. We found little evidence of associations with dust PM2.5.We introduced an approach for comparing the chemical compositions of PM2.5 sources across cities and conducted one of the first multicity studies of source-specific PM2.5 and ED visits. Across four U.S. cities, among the primary PM2.5 sources assessed, biomass burning PM2.5 was most strongly associated with respiratory health. Citation: Krall JR, Mulholland JA, Russell AG, Balachandran S, Winquist A, Tolbert PE, Waller LA, Sarnat SE. 2017. Associations between source-specific fine particulate matter and emergency department visits for respiratory disease in four U.S. cities. Environ Health Perspect 125:97-103;?http://dx.doi.org/10.1289/EHP271.

Project description:Background: Recent research has found a high rate of emergency department (ED) use after lower extremity arthroplasty; one study found a risk factor for ED presentation after lower extremity arthroplasty was presentation to the ED in the year prior to surgery. It is not known whether a similar association exists for total shoulder arthroplasty (TSA). Questions/Purposes: The goal of this study was to investigate the relationship between preoperative ED visits and postoperative ED visits after anatomic TSA. Methods: The 100% Medicare database was queried for patients who underwent anatomic TSA from 2005 to 2014. Emergency department visits within the year prior to the date of TSA were identified. Patients were additionally stratified by the number and timing of preoperative ED visits. The primary outcome measure was one or more postoperative ED visits within 90 days. A multivariate logistic regression analysis was used to control for patient demographics and comorbidities. Results: Of the 144,338 patients identified, 32,948 (22.8%) had an ED visit in the year prior to surgery. Patients with at least 1 ED visit in the year before surgery presented to the ED at a significantly higher rate than patients without preoperative ED visits (16% versus 6%). An ED visit in the year prior to TSA was the most significant risk factor for postoperative ED visits (in the multivariate analysis). The number of preoperative ED visits in the year prior to surgery demonstrated a significant dose-response relationship with increasing risk of postoperative ED visits. Conclusions: Postoperative ED visits occurred in nearly 10% of Medicare patients who underwent TSA in the period studied. More frequent presentation to the ED in the year prior to anatomic TSA was associated with increasing risk of postoperative ED visits. Future studies are needed to investigate the reasons for preoperative ED visits and if any modifiable risk factors are present to improve the ability to risk stratify and optimize patients for elective TSA.

Dataset Information

U.S. Emergency Department Visits Resulting From Nonmedical Use of Pharmaceuticals, 2016.

Publications

U.S. Emergency Department Visits Resulting From Nonmedical Use of Pharmaceuticals, 2016.

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