Medication Overdoses Leading to Emergency Department Visits Among Children

Background

The high prevalence of medication use increases the potential for medication overdoses, especially among children.

Purpose

This paper describes the burden of unintentional pediatric medication overdoses in order to target new prevention efforts.

Methods

Data were analyzed in 2007 and 2008 from the National Electronic Injury Surveillance System, collected January 1, 2004, through December 31, 2005, to estimate the number of emergency department visits resulting from unintentional medication overdoses among children aged ≤18 years in the U.S. These data were analyzed by patient demographics, overdose cause, and implicated products, and compared to visits for nonpharmaceutical consumer product poisonings.

Results

Based on 3034 cases, an estimated 71,224 emergency department visits for medication overdoses were made annually by children aged ≤18 years, representing 68.9% of emergency department visits for unintentional pediatric poisonings. The rate of unintentional poisonings from medications was twice the rate of those from nonpharmaceutical consumer products (9.2 visits per 10,000 individuals per year [95% CI=7.3, 11.0] vs 4.2 per 10,000 individuals per year [95% CI=3.3, 5.0]). Four fifths (82.2%) of visits for medication overdoses were from unsupervised ingestions (children accessing medications on their own); medication errors and misuse resulted in 14.3% of visits. Most visits (81.3%) involved children aged ≤5 years, and commonly available over-the-counter medications were implicated in one third (33.9%) of visits.

Conclusions

Medication overdoses among children, notably unsupervised ingestions, represent a substantial burden in terms of emergency department visits and hospitalizations. New efforts to prevent pediatric medication overdoses are needed.

Introduction

Outpatient medication use is increasingly common in the U.S., with 82% of adults and 56% of children taking at least one medication every week. Use of multiple medications has also increased, with the prevalence of use of five or more medications among adults rising from 22% to 31% between 2000 and 2004.¹ The high frequency of medication usage and the rising number of medications stored in American homes increases the potential for medication overdoses in ambulatory settings, especially among children.

Poison control center triage is currently performed to treat overexposure to many types of products—nonpharmaceutical consumer products such as cleaning substances, pesticides, and personal care products, as well as medication overdoses. Although there has been an overall decline in the number of calls to poison control centers for poisoning exposures among children aged ≤5 years, the proportion of calls for overexposures to medications has increased from 34% to 44% from 2002 to 2006.2, 3 It has been previously estimated⁴ that more than 70,000 children aged ≤18 years are treated in U.S. emergency departments for unintentional medication overdoses annually, but the underlying causes and risk factors for unintentional medication overdoses have not been well described. Studies have focused on unintentional poisoning exposures in children⁵ or on pediatric medication errors,6, 7 but nationally representative data on the scope, burden, and causes of medication overdoses are needed to help prioritize and target new efforts to prevent unintentional medication overdoses.⁸ In this report, a nationally representative public health surveillance system is used to describe outpatient pediatric medication overdoses that led to emergency department visits, and identify underlying causes. The magnitude of the burden of medication overdoses is described by comparing medication overdoses to unintentional poisonings from nonpharmaceutical consumer products.