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Open Access Original research

Drug - related emergency department visits by elderly patients presenting with non-specific complaints

Christian H Nickel1*, Juliane M Ruedinger1, Anna S Messmer1, Silke Maile1, Arno Peng1, Michael Bodmer12, Reto W Kressig3, Stephan Kraehenbuehl2 and Roland Bingisser1

  • * Corresponding author: Christian H Nickel nickelc@uhbs.ch

  • † Equal contributors

Author Affiliations

1 Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland

2 Department of Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland

3 Department of Acute Geriatrics, University Hospital Basel, Basel, Switzerland

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:15  doi:10.1186/1757-7241-21-15

Published: 5 March 2013

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

Elderly patients with non-specific complaints need to be screened systematically for drug-related problems.

Trial Registration

ClinicalTrials.gov: NCT00920491