Which adverse events are related to health care during hospitalization in elderly inpatients?

BACKGROUND: Adverse events result in longer hospital stays and increase costs and mortality. We aimed to assess incidence of adverse events occurring during hospitalization in a post-emergency unit and to describe their characteristics. METHODS: All adverse events occurring in patients during their hospitalization in a post-emergency unit in a French university hospital (20 beds) were systematically and consecutively recorded from September 2009 to February 2011. Patients with adverse events were compared to up to three control patients, matched for date of admission +/- age in the same unit. RESULTS: We identified 56 patients with 64 adverse events, giving an incidence of 3.0/100 patients admitted/year. Fifty-one adverse events were drug-related. Patients had a median age of 82.5 years with a male/female ratio of 1/1.4. They presented a median Charlson score of 1 and the median number of medications was 6. The drugs most frequently involved in drug-related events were nervous system drugs (47%) and anti-infectives (22%). In multivariate analysis, a Charlson score ≥ 2 was associated with the occurrence of adverse events (OR 0.4; 95% CI [0.21 - 0.80]). CONCLUSIONS: Systematic recording showed that adverse events were not rare in a post-emergency unit. Patients with comorbid conditions were less likely to present an adverse event, possibly because of greater precautions taken by the medical team.

Cannabis-related hospitalizations: unexpected serious events identified through hospital databases.

AIMS: Cannabis is the most prevalent illicit drug used worldwide and can be responsible for serious health defects in users. However, the risk related to cannabis consumption is not well established. The present study aimed to assess cannabis-related adverse events leading to hospitalization, and to estimate the corresponding annual risk for consumers. METHODS: Participants were patients admitted to the public hospitals in the Toulouse area (France) between January 2004 and December 2007 in relation to the use of cannabis. Reasons for admission and other occurring events were identified through hospital discharge summaries. We described all observed adverse events (AEs) and estimated their regional incidence on the basis of cannabis consumption data. RESULTS: We included 200 patients, and identified a total of 619 adverse events (AEs), one of which was lethal. Psychiatric disorders involved 57.7% of patients and accounted for 18.2% of AEs. Most frequent outcomes were central and peripheral nervous system disorders (15.8% of AEs), acute intoxication (12.1%), respiratory system disorders (11.1%) and cardiovascular disorders (9.5%). We estimated that in 2007 the incidence of cannabis-related AEs in the Midi-Pyrenees region ranged from 1.2 per 1000 regular cannabis users (95% confidence interval (CI) 0.7, 1.6) to 3.2 (95% CI 2.5, 3.9). CONCLUSIONS: Cannabis use is associated with complications, considered to be serious since they lead to hospitalization. Beyond the well-known and widely investigated psychiatric events, serious cerebro and cardiovascular complications have been identified. These findings contribute to improve the knowledge of cannabis-related adverse events.

Harmful effect of saline infusion in a patient with glycyrrhizic acid poisoning.

Alcohol-free licorice beverages contain glycyrrhizic acid. Excess glycyrrhizic acid is a well-known cause of excess mineralocorticoid syndrome. We report a case of glycyrrhizic acid poisoning in an abstinent alcoholic complicated by severe pulmonary edema following excessive hydration with intravenous normal saline.

Hospitalizations because of adverse drug reactions in elderly patients admitted through the emergency department: a prospective survey.

BACKGROUND AND OBJECTIVES: Several studies have been conducted to determine the frequency and characteristics of adverse drug reactions (ADRs) in elderly populations, focusing on those leading to hospital admission. However, most of these studies have been limited in their ability to assess risk factors, particularly the renal status of patients. Thus, the aim of this prospective study was to assess the incidence of ADRs and associated factors leading to hospital admissions in the elderly population. METHODS: All patients aged > or =65 years admitted to the Toulouse University Hospital through the Emergency Department during four non-consecutive weeks in 2002-3 were included in this study except for patients in ambulatory care or admitted for intentional overdoses. The characteristics of patients admitted for a suspected ADR were compared with those of patients admitted for other reasons. RESULTS: The incidence of hospital admissions for ADRs was 8.37 per 100 admissions (95% CI 6.52, 10.52), corresponding to 66 patients with ADRs among 789 admissions. The most important factors associated with ADRs were the number of drugs being taken (odds ratio [OR] 1.18; 95% CI 1.08, 1.29), self-medication (OR 2.34; 95% CI 1.18, 4.66), use of antithrombotics (Anatomic Therapeutic and Chemical [ATC] classification B01; OR 2.26; 95% CI 1.33, 3.88) and use of antibacterial drugs (ATC J01; OR 4.04; 95% CI 1.50, 10.83). Surprisingly, exposure to drugs for acid-related disorders was associated with a low risk of ADRs (OR 0.26; 95% CI 0.09, 0.76). CONCLUSION: A significant incidence of ADRs leading to hospital admissions was found among elderly people. Our study showed that there is a need to increase the availability of information for the general public concerning potential ADRs due to self-medication and for prescribers concerning ADRs due to drug-drug interactions and polypharmacy.

Assessing the feasibility of using an adverse drug reaction preventability scale in clinical practice: a study in a French emergency department.

OBJECTIVE: To assess the preventability of adverse drug reactions (ADRs) leading to hospital admissions and to investigate the feasibility of the use of a standardised preventability scale in clinical practice. DESIGN: The study was a prospective pharmacovigilance study. All patients more than 15 years old admitted to an emergency department during a period of 4 weeks were included. Characteristics of patients admitted for a suspected ADR (cases) were compared to those admitted for other reasons (controls). Preventability was assessed in two different ways: (i). by using a standardised preventability scale; and (ii). by the assessment of four reviewers without the scale. Results of the two methods were compared. PATIENTS: In total, 671 patients were admitted to an emergency department during the study period. RESULTS: Overall, 44 ADRs were identified involving 41 patients. The incidence of hospital admissions for ADRs was 6.1 per 100 admissions (95% CI 4.4-8.3). According to the French causality assessment method, 71% of ADRs were 'possible', 18% were 'plausible' and 11% were 'likely'. Using the standardised preventability scale, one-third of all ADRs were considered as being preventable (9% 'definitely' and 25% 'potentially' preventable). Reviewers found that 54.5% of ADRs were 'preventable'. Discrepancies between the two methods concerned mainly cases defined as not preventable by the scale. In general, reviewers overestimated the preventability of ADR compared with the scale. CONCLUSIONS: These results emphasise that ADRs leading to hospitalisation are frequent, with one-third of them likely to be preventable. Moreover, the risk of ADRs mainly involved a small number of drugs. Our experience suggests that there is a need for further studies to validate the French standardised scale of preventability assessment.