Which Adverse Events and Which Drugs Are Implicated in Drug-Related Hospital Admissions? A Systematic Review and Meta-Analysis

Abstract

Adverse drug events (ADEs) and adverse drug reactions (ADRs) are leading causes of iatrogenic injury, which can result in emergency department (ED) visits or admissions to inpatient wards. The aim of this systematic review and meta-analysis was to provide up-to-date estimates of the prevalence of (preventable) drug-related ED visits and hospital admissions, as well as the type and prevalence of implicated ADRs/ADEs and drugs. A literature search of studies published between January 2012 and December 2021 was performed in PubMed, Medline, EMBASE, Cochrane Library, and Web of Science. Retrospective and prospective observational studies investigating acute admissions to EDs or inpatient wards due to ADRs or ADEs in the general population were included. Meta-analyses of prevalence rates were conducted using generalized linear mixed models (GLMM) with the random-effect method. Seventeen studies reporting ADRs and/or ADEs were eligible for inclusion. The prevalence rates of ADR- and ADE-related admissions to EDs or inpatient wards were estimated at 8.3% ([95% CI, 6.4–10.7%]) and 13.9% ([95% CI, 8.1–22.8%]), respectively, of which almost half (ADRs: 44.7% [95% CI: 28.1; 62.4]) and more than two thirds (ADEs: 71.0% [95% CI, 65.9–75.6%]) had been classified as at least possibly preventable. The ADR categories most frequently implicated in ADR-related admissions were gastrointestinal disorders, electrolyte disturbances, bleeding events, and renal and urinary disorders. Nervous system drugs were found to be the most commonly implicated drug groups, followed by cardiovascular and antithrombotic agents. Our findings demonstrate that ADR-related admissions to EDs and inpatient wards still represent a major and often preventable health care problem. In comparison to previous systematic reviews, cardiovascular and antithrombotic drugs remain common causes of drug-related admissions, while nervous system drugs appear to have become more commonly implicated. These developments may be considered in future efforts to improve medication safety in primary care.

Increasing trend in hospitalisation due to adverse drug reactions: can we stem the tide?

“…Evidence collected from one region in England has demonstrated that medication-related harm resulting in admission to hospital has more than doubled from 6.5% (95% CI 6.2% to 6.9%) in 2004 to 16.5% (95% CI 16.3% to 20.7%) in 2021 1 2. A recent meta-analysis (17 studies) estimated a prevalence rate of 8.3% (95% CI 6.4% to 10.7%) for adverse drug reaction (ADR)-related admissions and 13.9% (95% CI 8.1% to 22.8%) for adverse drug event-related admissions in similar studies worldwide 3. At least a third of ADRs may be preventable, although estimates of preventability vary between different studies because of case mix and the tools used to assess preventability.…”

Efficacy and safety comparison of esketamine-propofol with nalbuphine-propofol for upper gastrointestinal endoscopy in children: a multi-center randomized controlled trial

“…Propofol's anesthetic effects is exerted as an allosteric potentiator and agonist of the gamma-aminobutyric acid type A (GABAA) receptor, by potentiating the central inhibitory gamma-aminobutyric acid (GABA) neurotransmitter ( 8 ). There are some adverse drug reactions (ADRs) of propofol should be considered, such as pain on induction, hemodynamic instability as well as cardiovascular and respiratory depression in a dose-dependent way ( 9 ). Combining anesthetics could reduce both medication dosages and dose-related adverse events.…”

Better prescribing for safer, more effective healthcare

“…Alongside possible benefits, all medicines have the potential to cause harm, ranging from minor self-limiting problems to serious adverse effects requiring hospitalisation or worse. A recent meta-analysis estimated that about 10% of hospital admissions are related to adverse drug reactions and adverse drug events, with many being potentially avoidable 6. Prescribing errors constitute a substantial proportion of all medication errors (20% by one estimate),7 despite the optimisation of electronic prescribing 8.…”