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Mital R, Lovegrove MC, Moro RN, Geller AI, Weidle NJ, Lind JN, Budnitz DS. US emergency department visits for acute harms from over-the-counter cough and cold medications, 2017-2019. Pharmacoepidemiol Drug Saf 2022; 31:225-234. [PMID: 34757641 PMCID: PMC10917081 DOI: 10.1002/pds.5384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/06/2021] [Accepted: 11/05/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Characterization of emergency department (ED) visits for acute harms related to use of over-the-counter cough and cold medications (CCMs) by patient demographics, intent of CCM use, concurrent substance use, and clinical manifestations can help guide prevention of medication harms. METHODS Public health surveillance data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project were used to estimate numbers and population rates of ED visits from 2017 to 2019. RESULTS Based on 1396 surveillance cases, there were an estimated 26 735 (95% CI, 21 679-31 791) US ED visits for CCM-related harms annually, accounting for 1.3% (95% CI, 1.2-1.5%) of all ED visits for medication adverse events. Three fifths (61.4%, 95% CI, 55.6-67.2%) of these visits were attributed to non-therapeutic CCM use (nonmedical use, self-harm, unsupervised pediatric exposures). Most visits by children aged <4 years (74.0%, 95% CI, 59.7-88.3%) were for unsupervised CCM exposures. Proportion hospitalized was higher for visits for self-harm (76.5%, 95% CI, 68.9-84.2%) than for visits for nonmedical use (30.3%, 95% CI, 21.1-39.6%) and therapeutic use (8.8%, 95% CI, 5.9-11.8%). Overall, estimated population rates of ED visits for CCM-related harms were higher for patients aged 12-34 years (16.5 per 100 000, 95% CI, 13.0-20.0) compared with patients aged <12 years (5.1 per 100 000, 95% CI, 3.6-6.5) and ≥ 35 years (4.3 per 100 000, 95% CI, 3.4-5.1). Concurrent use of other medications, illicit drugs, or alcohol was frequent in ED visits for nonmedical use (61.3%) and self-harm (75.9%). CONCLUSIONS Continued national surveillance of CCM-related harms can assess progress toward safer use.
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Affiliation(s)
- Rohan Mital
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Maribeth C Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Ruth N Moro
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Andrew I Geller
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Nina J Weidle
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
- Eagle Global Scientific, LLC (contractor to CDC), Atlanta, Georgia, USA
| | - Jennifer N Lind
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Daniel S Budnitz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Wang GS, Reynolds KM, Banner W, Bond GR, Kauffman RE, Palmer RB, Paul IM, Rapp-Olsson M, Green JL, Dart RC. Adverse Events Related to Accidental Unintentional Ingestions From Cough and Cold Medications in Children. Pediatr Emerg Care 2022; 38:e100-e104. [PMID: 32576790 DOI: 10.1097/pec.0000000000002166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Previous research has demonstrated that accidental unsupervised ingestions (AUIs) were responsible for the majority of cough and cold medication (CCM) ingestions leading to significant adverse events (AEs) in children. The objective of this analysis was to characterize the role of AUIs in the morbidity associated with CCM exposure in children. METHODS This surveillance study collected data from 5 United States data sources from 2009 to 2016, in children younger than 6 years with an AE from an AUI involving at least 1 CCM over-the-counter pharmaceutical ingredient. An expert panel reviewed each case to determine causality. RESULTS From 4756 total cases reviewed, 3134 (65.9%) had an AE from an AUI determined to be at least potentially related to a CCM ingredient. The majority (61.3%) of cases occurred in children aged 2 to younger than 4 years. Most exposures occurred in the child's own residence (94.9%), and 43.8% were admitted to a health care facility (22.0% to a critical care unit). Dextromethorphan and diphenhydramine, when packaged alone or in combination products, contributed to 96.0% of AUIs. The most common specific products involved were single-ingredient pediatric liquid diphenhydramine (30.1%) and single-ingredient pediatric liquid dextromethorphan (21.4%). There were 3 deaths from solid diphenhydramine formulations. CONCLUSIONS There continues to be opportunities for the implementation of interventions to prevent AUIs of CCM in children. Additional emphasis on engineering controls, such as flow restrictors for liquid formulations targeting diphenhydramine and dextromethorphan products, represent additional opportunities to further reduce AEs from AUIs of CCM.
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Affiliation(s)
| | - Kate M Reynolds
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | - William Banner
- Oklahoma Center for Poison and Drug Information, Oklahoma University College of Pharmacy, Oklahoma City, OK
| | - G Randall Bond
- Faculté de Médecine, Hope Africa University, Bujumbura, Burundi
| | - Ralph E Kauffman
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Robert B Palmer
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | - Ian M Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Malin Rapp-Olsson
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO
| | | | - Richard C Dart
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO
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Wang GS, Green JL, Reynolds KM, Banner W, Bond GR, Kauffman RE, Palmer RB, Paul IM, Rapp-Olsson M, Dart RC. Trends in adverse events and related health-care facility utilization from cough and cold medication exposures in children. Clin Toxicol (Phila) 2020; 59:351-354. [PMID: 32914676 DOI: 10.1080/15563650.2020.1815761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Initial research following regulatory changes addressing the pediatric safety of cough and cold medications (CCMs) demonstrated decreases in adverse events (AEs). Using a national multi-source surveillance system, we studied subsequent CCM-related AE case rate trends and associated health-care facility (HCF) evaluation in children. METHODS Data were collected from 2009 to 2016. Case eligibility included: age <12 years; exposure to an over-the-counter product containing ≥1 CCM pharmaceutical ingredient; ≥1 significant AE that occurred in the United States. RESULTS About 4756 (72.6%) cases were determined at least potentially related to an index ingredient. Accidental unsupervised ingestions (AUIs; 3134; 65.9%) were the most common case type. Nearly half of AE cases involved children 2 to <4 years old (2,159; 45.4%). The AE case rate did not change significantly over time (p = 0.22). The proportion of AE cases resulting in HCF admission increased from 32.4% (207) in 2009 to 43.4% (238) in 2016 (p < 0.01). Exposures to diphenhydramine (1,305; 67.3%) and/or dextromethorphan (591; 30.5%) were involved in the majority of HCF admissions. CONCLUSIONS The proportion of AE cases resulting in HCF admission increased from 2009 to 2016. Efforts to prevent AUIs such as packaging innovation and engineering controls, particularly for diphenhydramine and dextromethorphan-containing products, should be pursued.
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Affiliation(s)
- George Sam Wang
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA.,Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Jody L Green
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Kate M Reynolds
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - William Banner
- Oklahoma Center for Poison and Drug Information, Oklahoma University College of Pharmacy, Oklahoma City, OK, USA
| | - G Randall Bond
- Faculté de Médecine, Hope Africa University, Bujumbura, Burundi
| | - Ralph E Kauffman
- Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Robert B Palmer
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Ian M Paul
- Pediatrics & Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Malin Rapp-Olsson
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
| | - Richard C Dart
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
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Dorney K, Dodington JM, Rees CA, Farrell CA, Hanson HR, Lyons TW, Lee LK. Preventing injuries must be a priority to prevent disease in the twenty-first century. Pediatr Res 2020; 87:282-292. [PMID: 31466080 DOI: 10.1038/s41390-019-0549-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/03/2019] [Accepted: 08/13/2019] [Indexed: 02/08/2023]
Abstract
Injuries continue to be the leading cause of morbidity and mortality for children, adolescents, and young adults aged 1-24 years in industrialized countries in the twenty-first century. In this age group, injuries cause more fatalities than all other causes combined in the United States (U.S.). Importantly, many of these injuries are preventable. Annually in the U.S. there are >9 million emergency department visits for injuries and >16,000 deaths in children and adolescents aged 0-19 years. Among injury mechanisms, motor vehicle crashes, firearm suicide, and firearm homicide remain the leading mechanisms of injury-related death. More recently, poisoning has become a rapidly rising cause of both intentional and unintentional death in teenagers and young adults aged 15-24 years. For young children aged 1-5 years, water submersion injuries are the leading cause of death. Sports and home-related injuries are important mechanisms of nonfatal injuries. Preventing injuries, which potentially cause lifelong morbidity, as well as preventing injury deaths, must be a priority. A multi-pronged approach using legislation, advancing safety technology, improving the built environment, anticipatory guidance by clinical providers, and education of caregivers will be necessary to decrease and prevent injuries in the twenty-first century.
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Affiliation(s)
- Kate Dorney
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - James M Dodington
- Department of Pediatrics, Yale-New Haven Hospital, New Haven, CT, USA
| | - Chris A Rees
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Caitlin A Farrell
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Holly R Hanson
- Division of Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Todd W Lyons
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
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Or F, Kim Y, Simms J, Austin SB. Taking Stock of Dietary Supplements' Harmful Effects on Children, Adolescents, and Young Adults. J Adolesc Health 2019; 65:455-461. [PMID: 31176525 DOI: 10.1016/j.jadohealth.2019.03.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of the study was to evaluate the relationship between supplement categories and adverse events in children, adolescents, and young adults. METHODS This is a retrospective observational study using adverse event reports between January 2004 and April 2015 in the U.S. Food and Drug Administration Adverse Event Reporting System on food and dietary supplements database. We quantified the relative risks for severe medical events of dietary supplements sold for various functions relative to vitamins among individuals aged between 0 and 25 years. Severe medical events include death, disability, life-threatening events, hospitalization, emergency room visit, and/or required intervention to prevent permanent disability. RESULTS There were 977 single-supplement-related adverse event reports affecting individuals aged between 0 and 25 years over 11 years (50.6% female; age: mean = 16.5 years, standard deviation = 7.5 years). Supplements sold for muscle building (risk ratio [RR] = 2.7; 95% confidence interval [CI] = 1.9-4.0), energy (RR = 2.6; 95% CI = 1.9-3.6), and weight loss (RR = 2.6; 95% CI = 1.9-3.4) were associated with almost three times the risk for severe medical events compared with vitamins. CONCLUSIONS Consumption of dietary supplements sold for weight loss, muscle building, and energy involved increased risks for severe medical events compared with vitamins. Proactive enforcement of regulations is needed to reduce access and consumption among children, adolescents, and young adults.
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Affiliation(s)
- Flora Or
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Yongjoo Kim
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Juliana Simms
- Harvard University Information Technology, Cambridge, Massachusetts
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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Paul IM, Reynolds KM, Delva-Clark H, Burnham RI, Green JL. Flow Restrictors and Reduction of Accidental Ingestions of Over-the-Counter Medications. Am J Prev Med 2019; 56:e205-e213. [PMID: 31003808 DOI: 10.1016/j.amepre.2018.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Flow restrictors are child-resistant packaging innovations designed to limit the amount of liquid dispensed from a medication bottle. In 2011, flow restrictors were added to pediatric liquid single-ingredient acetaminophen formulations. The hypothesis of this study is that implementation would be associated with reduced volume and severity of pediatric acetaminophen exposures reported to the U.S. National Poison Data System. METHODS This study describes accidental unsupervised ingestions of acetaminophen in children aged <6 years. Exposures were grouped into pre-implementation (pre-period; January 4, 2010-July 17, 2011); transition (July 18, 2011-July 15, 2012); and post-implementation (post-period; July 16, 2012-December 25, 2016) periods. Cumulative and annual rates of change per million units (i.e., bottles) sold were calculated for the pre- and post-periods for acetaminophen and pediatric liquid ibuprofen (comparator without flow restrictors). Pre- to post-period rate ratios were used to compare products and to estimate the potential effect on other over-the-counter medications. Analysis was conducted in 2017 and 2018. RESULTS The pre- and post-period cumulative acetaminophen exposure rate was 507.2 (95% CI=481.1, 534.6) and 325.6 (95% CI=305.8, 346.7) per 1 million units sold, respectively. Declines in the pre- versus post-period rate ratios were seen for exposures with any effect (0.642, 95% CI=0.591, 0.696) and with clinically significant outcomes (0.728, 95% CI=0.581, 0.913). In the post-period, acetaminophen exposures decreased faster than ibuprofen with a rate of change ratio of 0.936 (95% CI=0.912, 0.960) for all exposures and 0.939 (95% CI=0.909, 0.970) for exposures with any effect. CONCLUSIONS The addition of flow restrictors to pediatric liquid acetaminophen was associated with a reduction in the number and severity of exposures. Application of flow restrictors to other liquid medications should be considered.
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Affiliation(s)
- Ian M Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kate M Reynolds
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado.
| | - Heather Delva-Clark
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - Randy I Burnham
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - Jody L Green
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado; Inflexxion, Inc., Waltham, Massachusetts
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Kahl LK, Stevens MW, Gielen AC, McDonald EM, Ryan L. Characteristics of opioid prescriptions for discharged pediatric emergency department patients with acute injuries. J Investig Med 2019; 67:1024-1027. [PMID: 31109930 DOI: 10.1136/jim-2019-001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/24/2019] [Accepted: 04/10/2019] [Indexed: 11/03/2022]
Abstract
This study describes the characteristics of opioid prescriptions for pediatric patients discharged from the emergency department (ED) with acute injuries, including type, formulation, quantity dispensed, and associations with patient age group and prescriber level of training. This retrospective cohort study enrolled all acutely injured patients receiving opioid prescriptions at discharge from an urban academic pediatric ED in a 1-year period. Electronic medical records were reviewed to abstract clinical and prescription data and prescriber level of training. Descriptive statistics were used for analysis. We identified 254 patients with injuries who received opioid prescriptions at ED discharge during the study period (mean age 9.5 years, 65% male). The most common injury was fracture (71%). Oxycodone was the opioid most frequently prescribed (96.1%). Liquid formulations were prescribed in 51.6% of cases. The median number of doses prescribed per prescription was 12 (SD±9.1), with a range of 1-50. Residents wrote 72.9% of prescriptions and prescribed more doses than non-residents (15.5 vs 12.2, p=0.01). Post-graduate year 2 (PGY2) residents prescribed more doses than PGY1 or PGY3+ residents. Our data show wide variation in the number of opioid doses prescribed to acutely injured pediatric patients at ED discharge and frequent use of liquid formulation; both factors may place this population at risk for accidental ingestion. These findings also support the development of pediatric clinical guidelines to define appropriate quantities of opioids to prescribe, promote poisoning prevention strategies, and design post-graduate education for medical trainees about safe prescribing practices.
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Affiliation(s)
- Lauren Krystine Kahl
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Martha W Stevens
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea C Gielen
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eileen M McDonald
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Leticia Ryan
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lovegrove MC, Weidle NJ, Budnitz DS. Ingestion of Over-the-Counter Liquid Medications: Emergency Department Visits by Children Aged Less Than 6 Years, 2012-2015. Am J Prev Med 2019; 56:288-292. [PMID: 30573336 PMCID: PMC6714556 DOI: 10.1016/j.amepre.2018.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Unintentional medication ingestions by young children lead to nearly 60,000 emergency department visits annually; 15% involve oral liquid medications. Safety packaging improvements have been shown to limit liquid medication ingestions. Estimated rates of emergency department visits for pediatric ingestions by product were calculated to help target interventions. METHODS Frequencies and rates of emergency department visits for unintentional pediatric ingestions were estimated using adverse event data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and retail sales/pharmacy dispensing data from Information Resources, Inc. and QuintilesIMS (collected 2012-2015; analyzed 2017). Rates of emergency department visits for ingestions of over-the-counter liquid medications were compared with those for prescription solid medications. RESULTS From the results of 568 cases, an estimated 6,427 emergency department visits (95% CI=4,907, 7,948) were made annually after a child aged <6 years accessed one of the four most commonly implicated over-the-counter liquid medications without caregiver oversight. Nearly two thirds (63.8%) of these visits were made by children aged ≤2 years and 9.0% resulted in hospitalization. Acetaminophen was the most commonly implicated over-the-counter liquid medication (2,515 estimated emergency department visits annually). Rates of emergency department visits for liquid diphenhydramine and acetaminophen ingestions (8.1 and 7.4 emergency department visits per 100,000 bottles sold) were higher than rates for other common over-the-counter liquids and comparable to high-rate prescription solid medications (clonidine and buprenorphine/naloxone: 11.1 and 10.5 emergency department visits per 100,000 dispensed prescriptions, respectively). CONCLUSIONS Product-specific rates of emergency department visits for unintentional ingestions can help prioritize preventive interventions, such as enhancing safety packaging with flow restrictors.
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Affiliation(s)
- Maribeth C Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nina J Weidle
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Eagle Medical Services, LLC, Atlanta, Georgia
| | - Daniel S Budnitz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
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Brass EP, Reynolds KM, Burnham RI, Green JL. Frequency of Poison Center Exposures for Pediatric Accidental Unsupervised Ingestions of Acetaminophen after the Introduction of Flow Restrictors. J Pediatr 2018; 198:254-259.e1. [PMID: 29622340 DOI: 10.1016/j.jpeds.2018.02.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/18/2018] [Accepted: 02/13/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To assess the temporal association of flow restrictor introduction and the rate of accidental unsupervised ingestions (AUIs) of liquid acetaminophen products. STUDY DESIGN The National Poison Data System was used to identify AUIs of single ingredient acetaminophen in patients aged <12 years reported between 2007 and 2015. Six regional poison centers obtained additional information using a structured telephone survey. RESULTS Pediatric AUIs involving acetaminophen averaged 30 000 exposures per year between 2007 and 2012. From 2012 to 2015, after flow restrictor introduction, exposures steadily decreased at a rate of 2400 fewer exposures annually, reaching 21 877 exposures in 2015. Normalized to sales volume, exposures involving liquid acetaminophen products decreased by 40% from 2010 to 2015. Exposures involving products with flow restrictors tended to have a lower estimated ingestion per exposure, fewer exposures exceeding a 150 mg/kg acetaminophen threshold, and were associated with lower rates of hospital admissions when compared with products without restrictors. Caregivers reported improper storage and child confusion of the medicine with treats as common contributing factors to exposures. CONCLUSIONS The introduction of flow restrictors was associated with a decrease in pediatric AUIs of liquid acetaminophen products. Decreases in the dose ingested and risk of hospital admission per exposure may also have resulted. Efforts to optimize flow restrictors and increase their use with medicines associated with high pediatric overdose risk should be encouraged.
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Affiliation(s)
- Eric P Brass
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kate M Reynolds
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO.
| | - Randy I Burnham
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO
| | - Jody L Green
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO
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10
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Wang GS, Severtson SG, Bau GE, Dart RC, Green JL. Unit-Dose Packaging and Unintentional Buprenorphine-Naloxone Exposures. Pediatrics 2018; 141:peds.2017-4232. [PMID: 29724879 DOI: 10.1542/peds.2017-4232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Buprenorphine accounts for the most opioid-related pediatric hospital admissions when compared with other opioid analgesics. Since 2010, several manufacturers began distributing their buprenorphine products with unit-dose packaging (UDP). Our main objective in this study is to evaluate the impact of UDP on unintentional pediatric buprenorphine-naloxone poison center exposures. METHODS This is an observational surveillance study in which the Researched Abuse, Diversion, and Addiction-Related Surveillance System Poison Center Program is used. The main outcome was cases of unintentional ingestions involving children <6 years old and buprenorphine-naloxone (combination) products. The study was split into 3 periods: pre-UDP (first quarter 2008 through fourth quarter 2010), transition to UDP (first quarter 2011 through fourth quarter 2012), and post-UDP (first quarter 2013 through fourth quarter 2016). RESULTS Overall, there were 6217 exposures to combination products. In the pre-UDP period, there were 20.57 pediatric unintentional exposures per 100 000 prescriptions dispensed; in the transition to UDP period, there were 8.77 pediatric unintentional exposures per 100 000 prescriptions dispensed; and in the post-UDP period, there were 4.36 pediatric unintentional exposures per 100 000 prescriptions dispensed. This represents a 78.8% (95% confidence interval: 76.1%-81.3%; P < .001) relative decrease from the pre-UDP period. CONCLUSIONS The shift from non-UDP to UDP in over 80% of buprenorphine-naloxone products was associated with a significant decrease in unintentional pediatric exposures reported to poison centers. Packaging controls should be a mainstay in the approach to the prevention of unintentional buprenorphine pediatric exposures as well as exposures to other prescription opioids.
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Affiliation(s)
- George Sam Wang
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado; .,Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - S Geoffrey Severtson
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - Gabrielle E Bau
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - Richard C Dart
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado.,Department of Emergency Medicine, School of Medicine, University of Colorado, Denver, Colorado; and
| | - Jody L Green
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado.,Inflexxion, Waltham, Massachusetts
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11
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Govindarajan P, Spiller HA, Casavant MJ, Chounthirath T, Smith GA. E-Cigarette and Liquid Nicotine Exposures Among Young Children. Pediatrics 2018; 141:peds.2017-3361. [PMID: 29686144 DOI: 10.1542/peds.2017-3361] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate exposures to liquid nicotine (including electronic cigarette devices and liquids) among children <6 years old in the United States and evaluate the impact of legislation requiring child-resistant packaging for liquid nicotine containers. METHODS Liquid nicotine exposure data from the National Poison Data System for January 2012 through April 2017 were analyzed. RESULTS There were 8269 liquid nicotine exposures among children <6 years old reported to US poison control centers during the study period. Most (92.5%) children were exposed through ingestion and 83.9% were children <3 years old. Among children exposed to liquid nicotine, 35.1% were treated and released from a health care facility, and 1.4% were admitted. The annual exposure rate per 100 000 children increased by 1398.2% from 0.7 in 2012 to 10.4 in 2015, and subsequently decreased by 19.8% from 2015 to 8.3 in 2016. Among states without a preexisting law requiring child-resistant packaging for liquid nicotine containers, there was a significant decrease in the mean number of exposures during the 9 months before compared with the 9 months after the federal child-resistant packaging law went into effect, averaging 4.4 (95% confidence interval: -7.1 to -1.7) fewer exposures per state after implementation of the law. CONCLUSIONS Pediatric exposures to liquid nicotine have decreased since January 2015, which may, in part, be attributable to legislation requiring child-resistant packaging and greater public awareness of risks associated with electronic cigarette products. Liquid nicotine continues to pose a serious risk for young children. Additional regulation of these products is warranted.
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Affiliation(s)
- Preethi Govindarajan
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Rutgers New Jersey Medical School, Newark, New Jersey
| | - Henry A Spiller
- Central Ohio Poison Center, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Marcel J Casavant
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Central Ohio Poison Center, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Thitphalak Chounthirath
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Gary A Smith
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; .,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and.,Child Injury Prevention Alliance, Columbus, Ohio
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12
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Rakowsky S, Spiller HA, Casavant MJ, Chounthirath T, Hodges NL, Kim EH, Smith GA. Antipyretic Medication Exposures Among Young Children Reported to US Poison Centers, 2000-2015. Clin Pediatr (Phila) 2018; 57:266-276. [PMID: 28952373 DOI: 10.1177/0009922817698124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study used the National Poison Data System database to retrospectively analyze the characteristics and medical outcomes of exposures to antipyretic medications involving children younger than 6 years in the United States. From 2000 through 2015, United States Poison Control Centers recorded an average of 74 387 antipyretic exposures annually among children younger than 6 years. Most exposures involved ibuprofen (55.1%) or acetaminophen (40.1%). From 2000 to 2009, the number of exposures increased by 73.0%, followed by a 25.2% decrease from 2009 to 2015. Children exposed to acetaminophen had 1.98 times higher odds of a serious medical outcome compared with those exposed to ibuprofen. Although generally safe at the correct dosage, antipyretic exposures continue to cause pediatric morbidity and, in rare cases, death. Prevention efforts should focus on reducing child access; educating caregivers about the potential dangers of antipyretics; and discouraging their use, except when needed to improve a child's comfort.
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Affiliation(s)
- Sofia Rakowsky
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA.,2 University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Henry A Spiller
- 3 Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA.,4 The Ohio State University College of Medicine, Columbus, OH, USA
| | - Marcel J Casavant
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA.,3 Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA.,4 The Ohio State University College of Medicine, Columbus, OH, USA
| | - Thiphalak Chounthirath
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA
| | - Nichole L Hodges
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA
| | - Eun Hye Kim
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA.,4 The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gary A Smith
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA.,4 The Ohio State University College of Medicine, Columbus, OH, USA.,5 Child Injury Prevention Alliance, Columbus, OH, USA
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13
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Tenenbein M. Child-resistant closure: yesterday, today and tomorrow. Inj Prev 2017; 24:2-4. [PMID: 29079579 DOI: 10.1136/injuryprev-2017-042577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 11/03/2022]
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14
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Green JL, Wang GS, Reynolds KM, Banner W, Bond GR, Kauffman RE, Palmer RB, Paul IM, Dart RC. Safety Profile of Cough and Cold Medication Use in Pediatrics. Pediatrics 2017; 139:peds.2016-3070. [PMID: 28562262 DOI: 10.1542/peds.2016-3070] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The safety of cough and cold medication (CCM) use in children has been questioned. We describe the safety profile of CCMs in children <12 years of age from a multisystem surveillance program. METHODS Cases with adverse events (AEs) after ingestion of at least 1 index CCM ingredient (brompheniramine, chlorpheniramine, dextromethorphan, diphenhydramine, doxylamine, guaifenesin, phenylephrine, and pseudoephedrine) in children <12 years of age were collected from 5 data sources. An expert panel determined relatedness, dose, intent, and risk factors. Case characteristics and AEs are described. RESULTS Of the 4202 cases reviewed, 3251 (77.4%) were determined to be at least potentially related to a CCM, with accidental unsupervised ingestions (67.1%) and medication errors (13.0%) the most common exposure types. Liquid (67.3%), pediatric (75.5%), and single-ingredient (77.5%) formulations were most commonly involved. AEs occurring in >20% of all cases included tachycardia, somnolence, hallucinations, ataxia, mydriasis, and agitation. Twenty cases (0.6%) resulted in death; most were in children <2 years of age (70.0%) and none involved a therapeutic dose. The overall reported AE rate was 0.573 cases per 1 million units (ie, tablets, gelatin capsules, or liquid equivalent) sold (95% confidence interval, 0.553-0.593) or 1 case per 1.75 million units. CONCLUSIONS The rate of AEs associated with CCMs in children was low. Fatalities occurred even less frequently. No fatality involved a therapeutic dose. Accidental unsupervised ingestions were the most common exposure types and single-ingredient, pediatric liquid formulations were the most commonly reported products. These characteristics present an opportunity for targeted prevention efforts.
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Affiliation(s)
- Jody L Green
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado;
| | - George Sam Wang
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kate M Reynolds
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - William Banner
- Oklahoma Center for Poison and Drug Information, Oklahoma University College of Pharmacy, Oklahoma City, Oklahoma
| | - G Randall Bond
- Faculty of Medicine, Hope Africa University, Bujumbura, Burundi
| | - Ralph E Kauffman
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and
| | - Robert B Palmer
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - Ian M Paul
- Departments of Pediatrics and.,Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Richard C Dart
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
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15
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Jo CL, Ambs A, Dresler CM, Backinger CL. Child-resistant and tamper-resistant packaging: A systematic review to inform tobacco packaging regulation. Prev Med 2017; 95:89-95. [PMID: 27939602 PMCID: PMC5299541 DOI: 10.1016/j.ypmed.2016.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/31/2016] [Accepted: 11/24/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to investigate the effects of special packaging (child-resistant, adult-friendly) and tamper-resistant packaging on health and behavioral outcomes in order to identify research gaps and implications for packaging standards for tobacco products. METHODS We searched seven databases for keywords related to special and tamper-resistant packaging, consulted experts, and reviewed citations of potentially relevant studies. 733 unique papers were identified. Two coders independently screened each title and abstract for eligibility. They then reviewed the full text of the remaining papers for a second round of eligibility screening. Included studies investigated a causal relationship between type of packaging or packaging regulation and behavioral or health outcomes and had a study population composed of consumers. Studies were excluded on the basis of publication type, if they were not peer-reviewed, and if they had low external validity. Two reviewers independently coded each paper for study and methodological characteristics and limitations. Discrepancies were discussed and resolved. RESULTS The review included eight studies: four assessing people's ability to access the contents of different packaging types and four evaluating the impact of packaging requirements on health-related outcomes. Child-resistant packaging was generally more difficult to open than non-child-resistant packaging. Child-resistant packaging requirements have been associated with reductions in child mortality. CONCLUSIONS Child-resistant packaging holds the expectation to reduce tobacco product poisonings among children under six.
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Affiliation(s)
- Catherine L Jo
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Anita Ambs
- Office of Science, Center for Tobacco Products (CTP), Food and Drug Administration (FDA), Rockville, MD, United States.
| | - Carolyn M Dresler
- Office of Science, Center for Tobacco Products (CTP), Food and Drug Administration (FDA), Rockville, MD, United States
| | - Cathy L Backinger
- Office of Science, Center for Tobacco Products (CTP), Food and Drug Administration (FDA), Rockville, MD, United States
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16
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Schwebel DC, Evans WD, Hoeffler SE, Marlenga BL, Nguyen SP, Jovanov E, Meltzer DO, Sheares BJ. Unintentional child poisoning risk: A review of causal factors and prevention studies. CHILDRENS HEALTH CARE 2016. [DOI: 10.1080/02739615.2015.1124775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Electronic nicotine delivery systems (ENDS) are rapidly growing in popularity among youth. ENDS are handheld devices that produce an aerosolized mixture from a solution typically containing concentrated nicotine, flavoring chemicals, and propylene glycol to be inhaled by the user. ENDS are marketed under a variety of names, most commonly electronic cigarettes and e-cigarettes. In 2014, more youth reported using ENDS than any other tobacco product. ENDS pose health risks to both users and nonusers. Nicotine, the major psychoactive ingredient in ENDS solutions, is both highly addictive and toxic. In addition to nicotine, other toxicants, carcinogens, and metal particles have been detected in solutions and aerosols of ENDS. Nonusers are involuntarily exposed to the emissions of these devices with secondhand and thirdhand aerosol. The concentrated and often flavored nicotine in ENDS solutions poses a poisoning risk for young children. Reports of acute nicotine toxicity from US poison control centers have been increasing, with at least 1 child death reported from unintentional exposure to a nicotine-containing ENDS solution. With flavors, design, and marketing that appeal to youth, ENDS threaten to renormalize and glamorize nicotine and tobacco product use. There is a critical need for ENDS regulation, legislative action, and counter promotion to protect youth. ENDS have the potential to addict a new generation of youth to nicotine and reverse more than 50 years of progress in tobacco control.
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18
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Lovegrove MC, Weidle NJ, Budnitz DS. Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures, 2004-2013. Pediatrics 2015; 136:e821-9. [PMID: 26347435 PMCID: PMC4651433 DOI: 10.1542/peds.2015-2092] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND After reports of increasing emergency department (ED) visits for unsupervised pediatric medication exposures in the 2000s, renewed efforts to improve safety packaging and education were initiated. National data on current trends can help further target interventions. METHODS We used nationally representative data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project (2004-2013) to assess trends in ED visits for unsupervised medication exposures in children aged <6 years. For 2010 through 2013, the dosage form and prescription status of implicated medications were identified. RESULTS Based on 13,268 cases, there were an estimated 640,161 ED visits (95% confidence interval: 512,885 to 767,436) for unsupervised medication exposures from 2004 through 2013. From 2004 through 2010, ED visits for unsupervised exposures increased by an average of 5.7% annually, peaking at 75,842. After 2010, this trend reversed, and visits decreased by an average of 6.7% annually to 59,092 in 2013. From 2010 through 2013, 91.0% of unsupervised exposure visits involved 1 medication, most commonly an oral prescription solid (45.9%), oral over-the-counter (OTC) solid (22.3%), or oral OTC liquid (12.4%). More than 260 different prescription solids were implicated; opioids (13.8%) and benzodiazepines (12.7%) were the most common classes. Four medications were implicated in 91.2% of OTC liquid exposure visits: acetaminophen (32.9%), cough and cold remedies (27.5%), ibuprofen (15.7%), and diphenhydramine (15.6%). CONCLUSIONS Targeting prevention efforts based on harm frequency and intervention feasibility can lead to continued reductions in ED visits for pediatric medication exposures.
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Affiliation(s)
- Maribeth C. Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Daniel S. Budnitz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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19
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Lovegrove MC, Mathew J, Hampp C, Governale L, Wysowski DK, Budnitz DS. Emergency hospitalizations for unsupervised prescription medication ingestions by young children. Pediatrics 2014; 134:e1009-16. [PMID: 25225137 PMCID: PMC4651431 DOI: 10.1542/peds.2014-0840] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Emergency department visits and subsequent hospitalizations of young children after unsupervised ingestions of prescription medications are increasing despite widespread use of child-resistant packaging and caregiver education efforts. Data on the medications implicated in ingestions are limited but could help identify prevention priorities and intervention strategies. METHODS We used nationally representative adverse drug event data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and national retail pharmacy prescription data from IMS Health to estimate the frequency and rates of emergency hospitalizations for unsupervised prescription medication ingestions by young children (2007-2011). RESULTS On the basis of 1513 surveillance cases, 9490 estimated emergency hospitalizations (95% confidence interval: 6420-12,560) occurred annually in the United States for unsupervised prescription medication ingestions among children aged <6 years from 2007 through 2011; 75.4% involved 1- or 2-year old children. Opioids (17.6%) and benzodiazepines (10.1%) were the most commonly implicated medication classes. The most commonly implicated active ingredients were buprenorphine (7.7%) and clonidine (7.4%). The top 12 active ingredients, alone or in combination with others, were implicated in nearly half (45.0%) of hospitalizations. Accounting for the number of unique patients who received dispensed prescriptions, the hospitalization rate for unsupervised ingestion of buprenorphine products was significantly higher than rates for all other commonly implicated medications and 97-fold higher than the rate for oxycodone products (200.1 vs 2.1 hospitalizations per 100,000 unique patients). CONCLUSIONS Focusing unsupervised ingestion prevention efforts on medications with the highest hospitalization rates may efficiently achieve large public health impact.
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Affiliation(s)
- Maribeth C Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | - Justin Mathew
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland; and
| | - Christian Hampp
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland; and
| | - Laura Governale
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland; and AstraZeneca, Patient Safety, Gaithersburg, Maryland
| | - Diane K Wysowski
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland; and
| | - Daniel S Budnitz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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Hampton LM, Nguyen DB, Edwards JR, Budnitz DS. Cough and cold medication adverse events after market withdrawal and labeling revision. Pediatrics 2013; 132:1047-54. [PMID: 24218462 PMCID: PMC4696492 DOI: 10.1542/peds.2013-2236] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In October 2007, manufacturers voluntarily withdrew over-the-counter (OTC) infant cough and cold medications (CCMs) from the US market. A year later, manufacturers announced OTC CCM labeling would be revised to warn against OTC CCM use by children aged <4 years. We determined whether emergency department (ED) visits for CCM adverse drug events (ADEs) declined after these interventions. METHODS We used National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance data from 2004 to 2011 to estimate the number of ED visits for CCM ADEs before and after each intervention. RESULTS Among children aged <2 years, ED visits for CCM ADEs decreased from 4.1% of all ADE ED visits before the market withdrawal to 2.4% of all ADE visits afterward (difference in proportion: -1.7%, 95% confidence interval [CI]: -2.7% to -0.6%). Among children aged 2 to 3 years, ED visits for CCM ADEs decreased from 9.5% of all ADE ED visits before the labeling revision announcement to 6.5% of all ADE visits afterward (difference in proportion: -3.0%, 95% CI: -5.4% to -0.6%). Unsupervised ingestions accounted for 64.3% (95% CI: 51.1% to 77.5%) of CCM ADE ED visits involving children aged <2 years after the withdrawal and 88.8% (95% CI: 83.8% to 93.8%) of visits involving children aged 2 to 3 years after the labeling revision announcement. CONCLUSIONS After a voluntary market withdrawal and labeling revision, ED visits for CCM ADEs declined among children aged <2 years and 2 to 3 years relative to ADE ED visits for all drugs. Interventions addressing unsupervised ingestions are needed to reduce CCM ADEs.
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Affiliation(s)
- Lee M. Hampton
- Division of Healthcare Quality Promotion, and,Address correspondence to Lee Hampton, MD, MSc, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-24, Atlanta, GA 30329. E-mail:
| | - Duc B. Nguyen
- Division of Healthcare Quality Promotion, and,Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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