Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures, 2004-2013

BACKGROUND: After reports of increasing emergency department (ED) visits for unsupervised abstract 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.