Abstract
PurposeTo identify the prevalence and preventability of adverse drug reactions (ADRs) in an emergency ward setting in a tertiary hospital in Sweden and to what extent the detected ADRs were reported to the Medical Product Agency (MPA).MethodsIn this prospective cross sectional observational study, 706 patients admitted to one of the Emergency Wards, at the Karolinska University Hospital in Solna, Stockholm during September 2008 –September 2009, were included. The electronic patient records were reviewed for patients’ demographic parameters, prevalence of possible ADRs and assessment of their preventability. In addition, the extent of formal and required ADR reporting to national registers was studied.ResultsApproximately 40 percent of the patient population had at least one possible ADR (n = 284). In the multivariable regression model, age and number of drugs were significantly associated with risk of presenting with an ADR (p<0.01 and p<0.001, respectively). Sex was not identified as a significant predictor of ADRs (p = 0.27). The most common ADRs were cardiovascular, followed by electrolyte disturbances, and hemorrhage. In 18 percent of the patient population ADRs were the reason for admission or had contributed to admission and 24% of these ADRs were assessed as preventable. The under-reporting of ADRs to the MPA was 99%.ConclusionsADRs are common in Emergency Medicine in tertiary care in Sweden, but under-reporting of ADRs is substantial. The most frequent ADRs are caused by cardiovascular drugs, and significantly associated with age and number of drugs. However, only a minority of the detected serious ADRs contributing to admission could have been avoided by increased risk awareness.
Highlights
Drug-related problems (DRP), including adverse drug reactions (ADRs), constitute a significant health- and quality problem affecting the elderly [1]
ADRs are common in Emergency Medicine in tertiary care in Sweden, but under-reporting of ADRs is substantial
The most frequent ADRs are caused by cardiovascular drugs, and significantly associated with age and number of drugs
Summary
Drug-related problems (DRP), including adverse drug reactions (ADRs), constitute a significant health- and quality problem affecting the elderly [1]. Based on prevalence studies in different settings, approximately 5 to 35% of hospital admissions are due to adverse drug reactions (ADR) [2,3,4,5,6,7,8]. In a small exploratory Swedish study, DRP including ADRs had either caused or contributed to almost one third of all admissions from the internal medicine emergency department in a tertiary care hospital [11]. In a Swedish study on elderly patients registered to receive home healthcare, 14% of hospital admissions were primarily caused by ADRs, with one-third of these ADRs related to impaired renal function, generally in very old women [26]
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