Table 2.
National Estimates of Emergency Department (ED) Visits for Over-the-Counter (OTC) Cough and Cold Medication (CCM)-related Harms, by Clinical Manifestations, 2017-2019a
| Manifestationsb | Therapeutic Use | Nonmedical Usec | Self-harm | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Cases | Annual Estimate | Cases | Annual Estimate | Cases | Annual Estimate | |||||||
| No. | No. | % | 95% CI | No. | No. | % | 95% CI | No. | No. | % | 95% CI | |
| Severe allergic reaction | 56 | 1,271 | 12.3 | (8.7 - 15.9) | 1 | -- | -- | -- | 0 | -- | -- | -- |
| Altered mental status/unresponsiveness | 54 | 1,227 | 11.9 | (8.2 - 15.6) | 199 | 3,533 | 44.9 | (37.3 - 52.5) | 75 | 1,583 | 21.4 | (13.5 - 29.4) |
| Presyncope/syncope/fall/injury | 61 | 1,367 | 13.2 | (9.1 - 17.4) | 20 | -- | -- | -- | 11 | -- | -- | -- |
| Psychiatric or other central nervous system effect | 50 | 1,275 | 12.4 | (8.9 - 15.9) | 34 | 591 | 7.5 | (4.6 - 10.4) | 9 | -- | -- | -- |
| Cardiovascular effect | 44 | 1,229 | 11.9 | (8.2 - 15.6) | 15 | -- | -- | -- | 11 | -- | -- | -- |
| Mild-to-moderate allergic reaction | 132 | 2,872 | 27.8 | (23 - 32.6) | 1 | -- | -- | -- | 0 | -- | -- | -- |
| Other effect | 33 | 694 | 6.7 | (3.3 - 10.1) | 20 | 470d | 6.0 | (2.4 - 9.5) | 32 | -- | -- | -- |
| Increased drug level only | 1 | -- | -- | -- | 4 | -- | -- | -- | 43 | 717 | 9.7 | (6.7 - 12.7) |
| No documented clinical manifestations | 23 | -- | -- | -- | 138 | 2,349 | 29.9 | (22 - 37.7) | 236 | 4,278 | 58.0 | (49.1 - 66.8) |
| Total | 454 | 10,319 | 100.0 | 432 | 7,870 | 100.0 | 417 | 7,382 | 100.0 | |||
CI = confidence interval.
Estimates are from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project, Centers for Disease Control and Prevention. Estimates based on <20 cases or total estimates <1200 for the study period are considered statistically unstable and are not shown (--). ED visits for unsupervised pediatric CCM exposures are not shown (1,164 estimated visits annually). There we no documented clinical manifestations for 74.1% of ED visits for unsupervised CCM exposures among children aged ≤10 years.
Clinical manifestations were categorized in a mutually exclusive and hierarchical manner (e.g., a case involving depressed consciousness and nausea would be classified as altered mental status/unresponsiveness based on the depressed consciousness). An estimated 61.3% of ED visits for nonmedical CCM use and 75.9% of visits for CCM-related self-harm had documentation of concurrent use of other medications, alcohol, or illicit drugs, and therefore it may be difficult to assess the role that the CCM played in the clinical manifestations, particularly for ED visits for harms involving non-therapeutic CCM use.
Nonmedical use includes abuse (clinician diagnosis of abuse or documentation of recreational use), misuse (using medication for symptom relief, but not using medication as directed), and overdoses without documentation of therapeutic intent, misuse, abuse, or self-harm.
Coefficient of variation >30%.