The frequency of adverse drug reaction related admissions according to method of detection, admission urgency and medical department specialty

BackgroundAdverse Drug Reactions (ADRs) have been regarded as a major public health problem since they represent a sizable percentage of admissions. Unfortunately, there is a wide variation of ADR related admissions among different studies. The aim of this study was to evaluate the frequency of ADR related admissions and its dependency on reporting and method of detection, urgency of admissions and included medical departments reflecting department/hospital type within one study.MethodsThe study team of internal medicine specialists retrospectively reviewed 520 randomly selected medical records (3%) of patients treated in the medical departments of the primary city and tertiary referral governmental hospital for certain ADRs causing admissions regarding WHO causality criteria. All medical records were checked for whether the treating physicians recognised and documented ADRs causing admissions. The hospital information system was checked to ensure ADR related diagnoses were properly coded and the database of a national spontaneous reporting system was searched for patients with ADRs included in this study.ResultsThe established frequency of admissions due to certain ADRs recognised by the study team and documented in medical records by the treating physicians was the same and represented 5.8% of all patients (30/520). The frequency of ADR causing admissions detected by employing a computer-assisted approach using an ICD-10 coding system was 0.2% (1/520), and no patient admitted due to ADRs was reported to the national reporting system (0/520). The recognized frequency of ADR related admissions also depends on the department's specialty (p = 0.001) and acceptance of urgently admitted patients (p = 0.001). Patients admitted due to ADRs were significantly older compared to patients without ADRs (p = 0.025). Gastrointestinal bleeding due to NSAID, acetylsalicylic acid and warfarin was the most common ADR that resulted in admission and represented 40% of all certain ADRs (12/30) according to WHO causality criteria.ConclusionADRs cause 5.8% of admissions in medical departments in the primary city and tertiary referral hospital. The physicians recognise certain ADR related admissions according to WHO causality criteria and note them in medical records, but they rarely code and report ADRs. The established frequency of ADR related admissions depends on the detection method, department specialty and frequency of urgently admitted patients.

[1]  P. Routledge,et al.  Adverse drug reactions in elderly patients. , 2003, British journal of clinical pharmacology.

[2]  P. Corey,et al.  Incidence of Adverse Drug Reactions in Hospitalized Patients , 2012 .

[3]  Anandi V Law,et al.  Adverse Drug Reactions Among Children Over a 10-Year Period , 2006, Pediatrics.

[4]  F. Follath,et al.  Epidemiology of drug exposure and adverse drug reactions in two swiss departments of internal medicine. , 2000, British journal of clinical pharmacology.

[5]  B. Bégaud,et al.  Under-reporting of adverse drug reactions Estimate based on a spontaneous reporting scheme and a sentinel system , 1998, European Journal of Clinical Pharmacology.

[6]  R E Ferner,et al.  Adverse drug reactions in patients admitted to hospital identified by discharge ICD-10 codes and by spontaneous reports. , 2001, British journal of clinical pharmacology.

[7]  C. Jorup-Rönström,et al.  Could Swedish ‘Yellow Cards’ Be Substituted by E-Coded Summaries? , 1990, Drug safety.

[8]  A. Rivkin.  Admissions to a medical intensive care unit related to adverse drug reactions. , 2007, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[9]  L. Hazell,et al.  Under-Reporting of Adverse Drug Reactions , 2006, Drug safety.

[10]  Josip Car,et al.  Trends in hospital admissions for adverse drug reactions in England: analysis of national hospital episode statistics 1998–2005 , 2007, BMC clinical pharmacology.

[11]  X. Vidal,et al.  An Intervention to Improve Spontaneous Adverse Drug Reaction Reporting by Hospital Physicians , 2009, Drug safety.

[12]  A. Avery,et al.  Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study , 2003, Quality & safety in health care.

[13]  Dictionaries and Coding in Pharmacovigilance , 2005 .

[14]  I R Edwards,et al.  Harmonisation in Pharmacovigilance , 1994, Drug safety.

[15]  U. Bergman,et al.  Adverse drug reactions causing hospitalization can be monitored from computerized medical records and thereby indicate the quality of drug utilization , 2006, Pharmacoepidemiology and drug safety.

[16]  H. Beijer,et al.  Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies , 2002, Pharmacy World and Science.

[17]  Miriam C.J.M. Sturkenboom,et al.  Adverse Drug Reaction-Related Hospitalisations , 2006, Drug safety.

[18]  J Hasford,et al.  Adverse drug reaction monitoring--cost and benefit considerations. Part I: frequency of adverse drug reactions causing hospital admissions. , 1997, Pharmacoepidemiology and drug safety.

[19]  F. Haramburu,et al.  Life-threatening adverse drug reactions at admission to medical intensive care: a prospective study in a teaching hospital , 2007, Intensive Care Medicine.

[20]  D Bajpai,et al.  Evaluation of the prevalence and economic burden of adverse drug reactions presenting to the medical emergency department of a tertiary referral centre: a prospective study , 2007, BMC clinical pharmacology.

[21]  P. McGettigan,et al.  Reporting of adverse drug reactions by hospital doctors and the response to intervention. , 2003, British journal of clinical pharmacology.

[22]  E. Hahn,et al.  Readmissions and adverse drug reactions in internal medicine: the economic impact , 2004, Journal of internal medicine.

[23]  I. Heineck,et al.  Adverse drug reactions: a cohort study in internal medicine units at a university hospital , 2006, European Journal of Clinical Pharmacology.

[24]  F. Haramburu,et al.  Admissions to hospital caused by adverse drug reactions: cross sectional incidence study , 2000, BMJ : British Medical Journal.

[25]  P. Waller,et al.  Hospital admissions for 'drug-induced' disorders in England: a study using the Hospital Episodes Statistics (HES) database. , 2005, British journal of clinical pharmacology.

[26]  M. Pirmohamed,et al.  Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients , 2004, BMJ : British Medical Journal.