Physician versus computer knowledge of potential drug interactions in the emergency department

Introduction: Proliferation of Food and Drug Administration-approved drugs makes it impossible for emergency medicine (EM) faculty to stay current on potential interactions between drugs, and with diseases, laboratory tests, and ethanol. A computer database may augment physician knowledge. Objective s: To compare the performance of EM faculty and an "expert" emergency physi cian (EP) with that of a criterion standard computer database in identifyin g potential drug interactions, and to report the incidence of drug-ethanol and drug-laboratory test interactions. Methods: This was a retrospective re view of 276 emergency department charts for drug, ethanol, lab, and medical history. Evaluation by both EM: faculty and an "expert" EP of patient hist ory was done to identify potential interactions, and comparison with the Mi cromedex Drug-Rear database for potential interactions (graded minor, moder ate, or major) was made. Clinical significance of potential interactions wa s judged by a second EM faculty member. Results: Seventeen percent of the p atients had potential drug-drug interactions, and 25% of these were judged to be clinically significant. Up to 52% of the patients had potential drug- ethanol interactions, while 38% of the patients could have potential drug-l ab interactions. Sensitivity, specificity, and positive and negative predic tive values of the EM faculty for potential drug-drug interactions compared with the computer were poor, at 14%, 58%, 6%, and 23%, respectively. The c orresponding values for the "expert" EP were 25%, 86%, 26%, and 85%. The "e xpert" EP was statistically better than the EM faculty, but still less sens itive and predictive than the computer. Conclusions: A computer can aid the physician in avoiding potential drug interactions. Prospective validation of these findings should be done.