(272) Changes in Pediatric Emergency Department Visits and Hospitalizations for Unintentional Exposures to Oral Prescription Medications in the United States, 2010-2021
Background: Emergency department (ED) hospitalizations for unintentional exposures involving prescription medications among young children from 2007-2011 commonly involved opioids, specifically, buprenorphine/naloxone. Patterns of prescription opioid use have changed substantially since 2011. Thus, assessing changes in the involvement of opioids and other medications in ED visits and hospitalizations among children is important.
Objectives: To characterize changes in the frequency of ED visits and hospitalizations for unintentional exposure to prescription medications among children < 6 years over two consecutive six-year periods.
Methods: We used National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance Project data to conduct a descriptive study of ED visits and hospitalizations for unintentional exposures to oral prescription medications by product among children < 6 years. We compared the frequency of medication involvement between 2010-2015 and 2016-2021. We calculated national estimates of ED visits and hospitalizations for prescription medications within each period then calculated utilization-adjusted rates of ED visits and hospitalizations per million dosage units dispensed using IQVIA dispensing estimates.
Results: From 2010-2015 to 2016-2021, the medication involved with the highest estimated number of ED visits among children ages < 6 years changed from clonazepam (9,864; 95% CI 6,529-13,198) to lisinopril (7,211; 95% CI 4,700-9,721). The number of ED visits involving buprenorphine/naloxone nominally declined from 6,316 (95% CI 3,697-8,935) in 2010-2015 to 3,564 (95% CI 1,550-5,578) in 2016-2021. Based on utilization-adjusted rates, guanfacine, buprenorphine/naloxone, aripiprazole, and clonidine were among the five prescription medications most involved in ED visits for children ages < 6 years in both 2010-2015 and 2016-2021. The utilization-adjusted rate of ED visits for all four of these drugs declined from 2010-2015 to 2016-2021. In both time periods, buprenorphine/naloxone, clonidine, and glipizide were among the five medications most involved in hospitalizations based on utilization-adjusted rates. The utilization-adjusted rate of pediatric hospitalizations per million dosage units was highest for buprenorphine/naloxone in both 2010-2015 (3.0; 95% CI 1.6-4.3) and 2016-2021 (1.2; 95% CI 0.4-2.0).
Conclusions: Buprenorphine/naloxone remains commonly involved in ED visits and hospitalizations for unintentional exposures among young children. However, rates of ED visits and hospitalizations involving buprenorphine/naloxone and other commonly implicated medications have nominally decreased. Further exploration of these declines may inform prevention strategies.
