Suspected adverse drug events requiring emergency department visits or hospital admissions.

OBJECTIVE: To analyse the contribution of adverse drug events (ADEs) to the overall number of referrals or visits at an emergency department, to determine the proportion of more severe episodes requiring hospital admission and to characterize the different causes of drug-related visits or admissions. METHODS: A 1-year prospective collection of data on visits performed at an emergency department. All visits, observed during 1 week every month, were analyzed in order to identify suspected ADEs. The effects of age and sex on the frequency of ADE-related visits and admissions were evaluated. All patients hospitalized because of an ADE were followed up in order to collect information about progress and outcome of the events, which were also assessed in terms of avoidability. RESULTS: Among the 5497 patients who visited the Emergency Department over 1 year, 235 (4.3%) experienced an ADE, 45 of these (19.1%) were subsequently hospitalized, among whom there were five deaths. Dose-related therapeutic failures were the main causes of drug-related admissions (55.6%), whereas adverse drug reactions caused the most frequent drug-related visits to the Emergency Department (63.8%). Although the frequency of drug-drug interactions leading to a visit to the Emergency Department was small (3.8%), this type of event was more severe, because most of these patients were hospitalized. No age/sex effect was observed in the proportion of ADE-related hospital admissions. Twenty-five (1.4% of the total admissions) of the 45 ADE-related admissions were evaluated as preventable, contributing by more than 61% of the overall length of hospital stay. CONCLUSION: The high proportion of drug therapeutic failures leading to an admission highlights the need for public education, particularly to prevent non-compliance.

Adverse events in the treatment of hypertensive patients.

We evaluated frequency and type of adverse events (AE) and measures adopted in outpatients attending a hospital hypertension unit in a two-part study: (1) a retrospective review of the charts of the 412 patients seen in 1991 with at least one follow-up visit and (2) a prospective study of the 491 patients seen in 1993 with at least one follow-up visit for whom physicians were asked to fill out an AE form. In 1991 18.6% of patients spontaneously reported an AE; those with an AE were older (p<0.001) than those without and included a greater proportion of females (p<0.002). This retrospective analysis of AE is reproducible as demonstrated by a blind review of 30 randomly selected charts undertaken by two independent observers (McNemar's test:p=ns). In 1993 AE were reported by 24.4% of patients who had more follow-up visits (p<0.001) and included a higher proportion of females (p=0.016) than the subgroup without AE. AE were different in the two studies (p<0.001), more specific and drug-related in 1993. AE were usually considered as mild or moderate (87.4%), the drugs most often involved were calcium antagonists and ACE-inhibitors and the measure adopted was switching to another substance (44%). The frequency of AE reporting varied widely between different physicians.