Khokan C. Sikdar

Adverse Drug Events in Adult Patients Leading to Emergency Department Visits

Background Adverse drug events (ADEs) occurring in the community and treated in emergency departments (EDs) have not been well studied. Objective To determine the prevalence, severity, and preventability of ADEs in patients presenting at EDs in 2 university-affiliated tertiary care hospitals in the Canadian province of Newfoundland and Labrador. Methods A retrospective chart review was conducted on a stratified random sample (n = 1458) of adults (≥18 y) who presented to EDs from January 1 to December 31, 2005. Prior to the chart review, the sample frame was developed by first eliminating visits that were clearly not the result of an ADE. The ED summary of each patient was initially reviewed by 2 trained reviewers in order to identify probable ADEs. All eligible charts were subsequently reviewed by a clinical team, consisting of 2 pharmacists and 2 ED physicians, to identify ADEs and determine their severity and preventability. Results Of the 1458 patients presenting to the 2 EDs, 55 were determined to have an ADE or a possible ADE (PADE). After a sample-weight adjustment, the prevalence of ADEs/PADEs was found to be 2.4%. Prevalence increased with age (0.7%, 18–44 y; 1.9%, 45–64 y; 7.8%, ≥65 y) and the mean age for patients with ADEs was higher than for those with no ADEs (69.9 vs 63.8 y; p < 0.01). A higher number of comorbidities and medications was associated with drug-related visits. Approximately 29% of the ADEs/PADEs identified were considered to be preventable, with 42% requiring hospitalization. Cardiovascular agents (37.4%) were the most common drug class associated with ADEs/PADEs. Conclusions Adult ADE-related ED visits are frequent in Newfoundland and Labrador, and in many cases are preventable. Further efforts are needed to reduce the occurrence of preventable ADEs leading to ED visits.

Adverse Drug Reactions in Elderly Hospitalized Patients: A 12-Year Population-Based Retrospective Cohort Study

BACKGROUND: Although research has identified some risk factors for first-time adverse drug reactions (ADRs), little is known about the risks associated with the number of ADRs. Modeling ADR counts is relatively complex because of the rarity of the events, requiring careful consideration of appropriate models that best present the observed data. OBJECTIVE: To determine the incidence of ADRs among elderly hospitalized patients, assess patient-related risk factors for the number of ADRs, and review drug classes commonly responsible for ADRs. METHODS: This retrospective cohort study used a population-based large administrative database on hospital separations from all acute care hospitals in the Canadian province of Newfoundland and Labrador. Patients aged 65 years or older with at least 1 hospital admission from April 1, 1995, to March 31, 2007, were included. Comorbidities, Charlson Comorbidity Index (CCI), and sociodemographic factors were assessed as predictors of ADR counts. A zero-inflated negative binomial regression model was used for analysis. RESULTS: The study cohort contained 64,446 patients. The incidence of ADRs was 15.2 per 1000 person-years (95% CI 14.8 to 15.7). Of those having an ADR, 15.4% had recurrent ADRs. The most common drug category implicated in ADRs was cardiovascular agents (17.7%). A dose-response relationship was found between CCI and ADR counts (rate ratio [RR] 1.67, 95% CI 1.41 to 1.98 for CCI 2-3; RR 2.38, 95% CI 1.98 to 2.87 for CCI 4-5; and RR 3.83, 95% CI 3.21-4.57 for CCI ≥6). Comorbid conditions including congestive heart failure (RR 1.58, 95% CI 1.33 to 1.89), diabetes (RR 2.42, 95% CI 1.64 to 3.56), and cancer (RR 3.12, 95% CI 2.58 to 3.76) were strong predictors. Rural areas (RR 1.22, 95% CI 1.01 to 1.46) were associated with increased risk for ADRs, whereas age and sex had no effect. CONCLUSIONS: Comorbidity from chronic diseases and severity of illness, rather than individual characteristics (advancing age and sex), increased the likelihood of ADRs. Changes in the delivery of care focusing on the monitoring of prescribed drugs in elderly patients with comorbidities could mitigate ADRs.

Unintentional injuries among children and adolescents in Aboriginal and non-Aboriginal communities, newfoundland and labrador, Canada

Objectives. To compare epidemiologic characteristics of unintentional injuries among children and adolescents in Aboriginal and non-Aboriginal communities in the Province of Newfoundland and Labrador (NL), Canada. Study design. A comparative population-based study of unintentional injuries among individuals 0–19 years was conducted among Aboriginal and non-Aboriginal communities in NL. Methods. The provincial hospital discharge and mortality data were analyzed for a 6-year period, April 1995 to March 2001. Rates and rate ratios related to hospital discharge and mortality due to unintentional injuries were calculated to assess variation of rates. The 2-independent sample binomial proportion test was used to compare rates between Aboriginal and non-Aboriginal communities. Results. The overall hospital discharge rates of unintentional injury in Aboriginal and non-Aboriginal communities were 1,132.0 and 614 .2 per 100,000 population, respectively (p(2)&0.001). For both Aboriginal and non-Aboriginal communities, the rate among males was higher than that of females (p(2)&0.001). The mortality rate was found to be higher in Aboriginal communities than non-Aboriginal communities (84.3 vs. 10.2 per 100,000 population) (p(2)&0.001). Conclusions. The rate of unintentional injury among children and adolescents in Aboriginal communities is higher than non-Aboriginal communities. Sex (male) and place of residence (Aboriginal communities) were strong predictors of unintentional injury in NL.

Systematized nomenclature of medicine clinical terms (SNOMED CT) to represent computed tomography procedures

OBJECTIVE To evaluate the ability of systematized nomenclature of medicine clinical terms (SNOMED CT) to represent computed tomography procedures in computed tomography dictionaries used in the Canadian province of Newfoundland and Labrador. METHODS This study was conducted in two stages. In the first stage computed tomography dictionaries were collected and consolidated to one master list. The duplicated procedure names were deleted from the list. In the second stage the unique data items from the master list were matched with the SNOMED CT concepts. Sensitivity, specificity, and positive and negative predictive values of SNOMED CT were investigated. RESULTS After eliminating 680 duplicate procedures from the total of 833, the study sample consisted of 153 data items. For pre-coordination, SNOMED CT had sensitivity of 56% and for post-coordination SNOMED CT had sensitivity of 98%. CONCLUSION Our results suggest that SNOMED CT is a valid nomenclature for representing computed tomography procedures.

Suicide in Newfoundland and Labrador: A Linkage Study Using Medical Examiner and Vital Statistics Data

Objective: To examine suicide epidemiology in Newfoundland and Labrador from 1997 to 2001. Method: Data from the Office of the Chief Medical Examiner (CME) were linked with data derived from the Canadian Vital Statistics Death Database. Ninety-five percent confidence intervals (CI) were calculated to assess variation of rates. We used the chi-square test to compare categorical data. Results: The CME recorded 225 suicide deaths, compared with 187 in the Canadian Vital Statistics Death Database. Most deaths not coded as suicide in the national database were coded as accidental. Using the CME data, the overall suicide rate was 9.5/100 000, aged 10 years and older. The rate among males (15.8/100 000, 95%CI, 10.7 to 20.8) was almost 5 times that of females (3.3/100 000; 95%CI, 1.0 to 5.5). Age-standardized rates decreased over the study period, from 10.9 to 8.0/100 000; however, the difference was not significant. The proportionate mortality ratio for suicide deaths was highest among those aged 10 to 19 years (20.0%) and decreased with age. The suicide rate was highest among those aged 50 to 59 years. The rate for unpartnered individuals (17.0/100 000, 95%CI, 10.7 to 23.0) was significantly higher, compared with partnered individuals (5.1/100 000; 95%CI, 2.5 to 7.8). Males used more violent methods than females. Suicide was significantly higher in Labrador (27.7/100 000, 95%CI, 18.4 to 37.0), an area with a higher Aboriginal population, compared with the island of Newfoundland (8.5/100 000, 95%CI, 7.3 to 9.7). Psychiatric illness was the most common predisposing factor. Conclusions: Suicide deaths are highest among males, unpartnered individuals, and individuals with psychiatric disorders.

Epidemiology of severe burn among children in Newfoundland and Labrador, Canada

PURPOSE The objective of this study was to identify the epidemiologic characteristics of childhood burns in the province of Newfoundland and Labrador. METHODS A population-based study was carried out on children aged 0-16 years who were hospitalized due to burns in Newfoundland and Labrador between April 1995 and March 2001. Hospital and mortality data were obtained from the provincial hospital admission database and Mortality System, respectively. The Newfoundland and Labrador population was considered as a whole and as two separate geographic areas. RESULTS A total of 157 hospital admissions due to burns were identified during the study period. The rate of burns requiring hospitalization in the province was 22.3 per 100,000 person-years (P-Y). The rates for males and females was 27.7 and 16.6 per 100,000 P-Y, respectively (P=0.006). Infants (0-1 year) had the highest rate of burn (88.8 per 100,000 P-Y) followed by children aged 2-4 years (26.0 per 100,000 P-Y) (P<0.0001). Labrador, a region with high Aboriginal population (51.4 per 100,000 P-Y), had a higher rate of burn compared to Newfoundland (20.3 per 100,000 P-Y) (P<0.0001). Median age of patients with burns was 2 years for the island portion of the province and 9 years in Labrador (P<0.01). Overall, scald burn (52.2%) was the most frequent type of burn followed by flame (32.5%). In the island portion of the province, scald burn was the most common type of burn (56.4%), while in Labrador flame was the most frequent type (66.7%). Overall mortality rate due to burns was 0.9 per 100,000 P-Y. CONCLUSION Age (infants) and sex (male) are factors associated with burn in Newfoundland and Labrador. Study results indicate a difference in the epidemiologic pattern of burn between the island portion of the province, Newfoundland, and mainland Labrador. It is recommended that preventive programs be directed towards high risk groups to reduce the incidence of burns.

Adverse drug events among children presenting to a hospital emergency department in Newfoundland and Labrador, Canada

The aim of this study was to examine epidemiologic characteristics of Adverse Drug Events (ADEs) among children and adolescents presenting to an Emergency Department (ED) in Newfoundland and Labrador (NL), Canada.