Frequency and cost of serious adverse drug reactions in a department of general medicine

Abstract

Aims To assess the frequency and cost of drug reactions causing or prolonging hospitalization. Methods All patients admitted to an internal medicine ward over 6 months were evaluated to identify serious adverse reactions. The number of drug classes on admission or at the time of the adverse drug reaction (ADR) was counted. Excess ADR-related hospital stay was computed using a) raw excess duration of hospital stay, b) correction of duration of hospital stay by age, sex, and number of drug classes, and c) estimation by investigator of excess hospital stay. Results Three hundred and twenty-nine patients were evaluated: 212 male, 117 female, mean age 57.2 (males: 52.2, females: 66.2 ( P<0.05)), range 17-95 years.

Incidence and Economic Burden of Adverse Drug Reactions among Elderly Patients in Ontario Emergency Departments

“…While some pharmacosurveillance studies include multicentre[3] or national hospital data,[4] most studies on ADRs have been conducted within a single hospital[5] or even a single medical department,[6] making it difficult to confidently extrapolate results to a general population. [7] As well, ADRs occur more commonly in community-dwelling patients[3] where data is not well documented and more difficult to obtain.…”

The diseases we cause: Iatrogenic illness in a department of internal medicine

“…Iatrogenic disease is a serious problem with a great social impact. It occurs very frequently, is expensive [3][4][5][6][7][8][12][13][14][15][16], and is potentially responsible for high morbidity and mortality [5,6,8,[12][13][14]17,18]. In the U.S., it is estimated that iatrogenic causes are responsible for 225,000 deaths each year, thus being the third leading cause of death after heart disease and cancer [5].…”

“…More recent studies show that iatrogenic events occur in 14-25% [10,19] of hospitalized patients in internal medicine departments and in 33% of patients over 65 years of age [18]. Almost onethird of the patients have iatrogenic disease before hospital admission [20] and 3-7% of all admissions have iatrogenic causes [10,15,16,21,22], increasing to almost 8% in patients over 65 years of age [11]. Iatrogenic events are also an important cause of admission to intensive care units (ICUs) [23][24][25][26][27] and of hospital readmission [28,29].…”

“…Little epidemiological data is available [6,10]. However, the few studies that are available have shown that there are some important predictors for the occurrence of iatrogenic events, namely, older age [10,11,14,[18][19][20][21], longer hospital stay [5,10,15,[18][19][20][21], number of drugs taken daily [11,15,18,21,32], associated pathologies [21], poor general medical status on admission [19], associated renal function impairment or failure [18], and IV catheterization [19]. Amongst the many types of iatrogenic diseases, the most common seem to be drugrelated [6,9,10,12,16,21,23,[30][31][32][33] or adverse drug reactions (ADRs).…”

“…Depending on the series, the drugs most often referred to are anti-hypertensive drugs (mainly diuretics), cardiovascular drugs (mainly digoxin and digitalics; up to 15%), NSAIDs (up to 12%), hypoglycemic agents (6-12%), anti-coagulants (10-11%), antibiotics (Abs; approximately 7%), and neuropsychiatric drugs [10,11,14,19,21,23]. The most frequent alterations found are serum electrolyte disturbances (including dehydration), metabolic/endocrine disorders, gastrointestinal and liver disorders, cardiovascular disorders, neuropsychiatric events, hematological disorders, and infectious and hemorrhagic complications [10,11,15,[17][18][19][20][21]. According to the definition of type A or B (Table 1), in order to be avoidable, an ADR must be predictable.…”