CP081 - Régulation pédiatrique - Incidence des appels pour un effet indésirable médicamenteux

Emilie Dehours (1), Badia Zeribi (2), Vincent Bounes (3), Isabelle Claudet (4), Genevieve Durrieu (5), Jean Louis Ducassé (6), Jean Louis Montastruc (7)

1. Pôle de médecine d'Urgences, Hôpital Purpan, Toulouse, France 2. Pôle de médecine d'Urgences, CHU TOULOUSE, Toulouse, France 3. Pôle de médecine d'Urgences, Hôpital Purpan, TOULOUSE, France 4. Urgences Pédiatriques, Hôpital Purpan, CHU TOULOUSE, TOULOUSE, France 5. Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicam, CHU TOULOUSE, TOULOUSE, France 6. Pôle de médecine d'Urgences SAMU31, Hôpital Purpan, TOULOUSE, France 7. Service de Pharmacologie Médicale et Clinique, CHU TOULOUSE, TOULOUSE, France

Diffusion le 06/12/2015

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Introduction : Chez l’enfant, les médicaments sont insuffisamment étudiés. La prescription médicamenteuse est particulièrement difficile et souvent hors autorisation de mise sur le marché. De plus, du fait d’un métabolisme différent de celui de l’adulte, les effets indésirables sont souvent différents de chez l’adulte. Enfin, le service d’aide médicale urgente (SAMU) étant une interface particulière entre la population générale et les établissements de santé, il nous a semblé important de s’intéresser à la pharmacovigilance au sein d’un SAMU en déterminant l'incidence des appels au centre de réception et de régulation des appels (CRRA) d’un SAMU pour un effet indésirable médicamenteux (EIM) ayant concerné un patient mineur.

Patients et Méthode : Etude rétrospective observationnelle, monocentrique entre le 1e janvier 2011 et le 31 décembre 2012. Nous avons inclus tous les dossiers de régulation médicale dont le diagnostic médical était codé en accident iatrogène, vomissements, malaise, vertiges, hémorragies, allergie ou hypoglycémie (définis lors d’une pré-étude). Le critère de jugement principal était la présence d’un EIM imputable à un médicament et ayant entraîné un appel au CRRA pour un enfant jusqu’à 18 ans exclus. Nous avons réalisé une analyse descriptive des données. Les statistiques étaient réalisées grâce au logiciel Excel° (Microsoft Corporation, 2007, Richmond, USA).

Résultats : Sur une période de 2 ans,250 EIM étaient inclus. L’incidence des appels au CRRA pour EIM était de 0,16%. Le sexe ratio était de 0,87 (117 hommes pour 133 femmes). L’EIM le plus fréquent était l’allergie (n=133; 53,2%) puis les vomissements (n=57; 22,8%). Au total, 336 médicaments étaient imputés puisque un patient pouvait avoir pris plusieurs médicaments en même temps. Les médicaments les plus fréquemment en cause étaient les antibiotiques (n=145; 43,2%), les antalgiques/antipyrétiques (n=41; 12,5%), les anti inflammatoires (n=27; 8,0%) et les vaccins (n=24; 7,1%). Les EIM graves (uniquement des hospitalisations) représentaient 1,6 % des EIM (n=4).

Conclusion : Cette étude est la première à définir cette incidence chez le patient mineur. Elle permet d’insister sur la nécessaire sensibilisation des médecins à la pharmacovigilance afin d’améliorer la prise en charge de cette population sensible. Elle contribue à avoir une meilleure visibilité sur les EIM en soins primaires.

Tags : pédiatrie régulation pharmacovigilance

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/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Adapter/Pdo/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Adapter/Pdo/Mysql.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Expr.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Profiler.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Select.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement/Pdo.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table/Definition.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Inflector.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/PregReplace.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/StringToLower.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/CamelCaseToDash.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/CamelCaseToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/Separator/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/SeparatorToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/UnderscoreToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout/Controller/Action/Helper/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout/Controller/Plugin/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/Autoloader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/PluginLoader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/PluginLoader/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Data.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Format.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Math.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/FactoryInterface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Priority.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Writer/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Registry.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Namespace.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/SaveHandler/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Uri.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Version.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Doctype.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadMeta.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadTitle.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Standalone.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Registry.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Url.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Interface.php

ZFDebug Files

/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Cache.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Database.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/File.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log/Writer.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Text.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Variables.php