For 2010, the most frequent causes of deaths from unintentional injury included motor vehicle crashes (33,687 people), poisoning (33,041), falls (26,009), suffocation (6,165), drowning (3,782), and fire (2,845). Unintentional injury was the largest cause of potential life-years lost before age 65 years. Additionally, for nonfatal injuries, falling was the most common injury, leading to more than 9 million emergency department visits. The top three causes of death for people aged 1-30 years were unintentional injury, suicide, and homicide, which together accounted for close to 80% of deaths in this group. About 20% of deaths among the young were related to chronic diseases and only 1% was from infectious diseases.
One area in which physician counseling may be able to save lives is in prescription drug overdoses, according to the report. Overdose can occur through intentional or unintentional means, although most deaths from overdose are unintentional. In 2010, 38,329 people in the United States died from a drug overdose. Prescription drugs were involved in 22,134 of these deaths (nearly 60%). An overdose of opioid analgesics such as oxycodone, hydrocodone, and methadone accounted for 75% of prescription drug deaths. Deaths from opioid analgesics have nearly quadrupled since 1990 and four times more prescription painkillers were sold to pharmacies, hospitals, and doctors’ offices in 2010 than in 1999. Drug overdose is commonly viewed as an issue of substance misuse, mental health, or law enforcement rather than an injury and public health concern; however, this rise in overdose deaths coincides with an increase in the supply of prescription painkillers, indicating a need for intervention from health professionals.
Also in 2010, the 31.2 million unintentional and violence-related nonfatal injuries cost more than $513 billion in medical care and lost productivity, and this figure does not include costs associated with nonmedically treated injuries, legal costs, or indirect costs from other health problems associated with or exacerbated by violence and injuries.
Innovations in health information technology, such as clinical decision support tools embedded within electronic health records, “could enhance health providers’ ability to provide injury preventive services [such as triggering] alerts for screening on the basis of risk factors for patients, provide real-time information about evidence-based treatment guidelines, generate reports that share information about injury prevention with patients or automate referrals to community services,” according to Dr Haegerich and her associates.
gtwachtman@frontlinemedcom.com
Emergency physicians may be overprescribing PPIs
BY: BRUCE JANCIN
AT SAEM 2014
DALLAS—The frequency at which U.S. emergency department physicians prescribed proton pump inhibitors more than doubled during 2001-2010, despite mounting safety concerns surrounding this class of medications.
“More education may be needed to ensure ED providers are familiar with the appropriate indications for PPI use. The big thing that I’m hoping will be taken away from this study is that because of the increase in prescribing PPIs [proton pump inhibitors] and the concerns about safety, that we’re going to be more vigilant in educating ourselves and each other about appropriate use of these medications,” Dr Maryann Mazer-Amirshahi said at the annual meeting of the Society for Academic Emergency Medicine.
Overprescribing of PPIs has been well documented in primary care offices, gastroenterology clinics, and inpatient settings. Up until now, however, prescribing patterns in the ED haven’t been well documented. The Centers for Disease Control and Prevention’s annual National Hospital Ambulatory Care Survey provided an opportunity to do so via a weighted nationally representative sample of ED visits, explained Dr Mazer-Amirshahi of Children’s National Medical Center, Washington.
She presented a retrospective analysis of survey data for the years 2001-2010, during which the annual number of adult ED visits climbed from 20.1 million to 28.3 million. Meanwhile, PPI prescribing increased from 3% of adult patients in 2001 to 7.2% in 2010.
“I think that’s pretty significant when you’re talking about more than 7% of 28 million ED visits every year,” she commented.
While PPI prescribing more than doubled during the study years, the use of alternative medications declined. Histamine2 blocker use dropped from 6.8% in 2001 to 5.7% in 2010, while the use of antacids decreased from 7.2% to 5.5%.
PPI prescribing rose in EDs in hospitals of all types: nonprofit, for-profit, and government. It increased in all regions of the country and across all payer types, including self-payment. Of note, the number of ED prescriptions increased to a greater extent in teaching hospitals, with a 276% increase, as compared with a 118% increase in nonteaching hospitals. Prescribing of PPIs by attending ED physicians climbed by 122%, by 185% by emergency medicine residents, and by 345% by mid-level providers.