Impact of the 2022 Pediatric Antipyretic Shortage on Emergency Department Utilization in Ontario and Alberta, Canada

BACKGROUND: In 2022, Canada experienced a shortage of pediatric acetaminophen and ibuprofen, raising concerns that reduced availability could increase emergency department use for febrile illness or acetaminophen-related poisoning in children. OBJECTIVE: To evaluate the impact of the pediatric antipyretic shortage on pediatric health service use and outcomes. METHODS: We conducted a population-based ecological time-series study using administrative health data from Ontario and Alberta, Canada, including national and provincial hospitalization and respiratory virus databases. We used generalized additive models and segmented negative binomial regression to estimate immediate and postshortage changes in rates of ED visits for fever and acetaminophen poisoning among children aged 0 to 11 years between the pre- (January 2018 to July 2022) and post- (August 2022 to March 2023) shortage periods. RESULTS: We identified 163,396 fever-related ED visits in Ontario and 58,070 visits in Alberta. The shortage was not associated with an immediate [Ontario rate ratio (RR) 1.08: 95% CI: 0.72-1.63] or trend change in Ontario (RR: 0.98; 95% CI: 0.92-1.04). Similar findings were observed in Alberta (RR: 0.88; 95% CI: 0.56-1.38 and RR: 0.99; 95% CI: 0.93-1.05, respectively). We identified 1998 ED visits for acetaminophen poisoning in Ontario and 906 visits in Alberta. In Alberta, the shortage was associated with an immediate decline in visits for acetaminophen poisoning (RR: 0.76; 95% CI: 0.67-0.87), followed by an increasing trend (RR: 1.04; 95% CI: 1.03-1.05). No such changes were observed in Ontario (RR: 0.98; 95% CI: 0.92-1.05 and RR: 1.01; 95% CI: 0.99-1.02, respectively). CONCLUSION: The 2022 pediatric antipyretic shortage was not associated with increased febrile illness-related ED visits in Ontario or Alberta. Interprovincial differences in the association between the shortage and ED visits for acetaminophen poisoning may reflect variation in mitigation strategies.