Adverse drug events are a major cause of acute medical admission
Abstract
BACKGROUND: Adverse drug events (ADE) contribute significantly to hospital admissions. Prospective New Zealand data are scant, and the ability of clinical coding to identify ADE associated admissions is uncertain. Outcomes after cessation of causative medications are unknown. AIMS: To assess the frequency, nature and causality of ADE associated with acute admissions to General Medicine at Christchurch Hospital. METHODS: Prospective observational study of patients admitted to our medical team over 20 weeks. RESULTS: Of 336 admissions, 96 (28.6%) were ADE related. Sixty-five (19.3%) were caused by an ADE, and 31 (9.2%) were contributed to by an ADE. The mean age of non-ADE patients was 64.3 years (range 16-91), which was similar to the mean age of ADE patients (65.9 years; 21-92). However, if intentional overdoses and recreational drug use were excluded, ADE patients were significantly older at 72.4 years (21-92) (P = 0.0007). ADE patients took more regular medications on admission (mean 6.6, range 0-22) than non-ADE patients (mean 5.0, 0-18), (P = 0.003). The average length of stay was similar. The commonest medications implicated were vasodilators, psychotropics and diuretics. The most common adverse effects were postural hypotension and/or vasovagal syncope (29% of ADE), intentional overdoses and recreational drug use (15%) and acute renal failure and/or clinical dehydration (10%). Seventy-six patients had culprit medications stopped or reduced, and this potentially contributed to six readmissions. Coding identified 61% of ADE associated admissions. CONCLUSION: ADE are a common cause of hospital admission. The most frequent problems are postural hypotension and vasovagal syncope, intentional drug misuse and dehydration.
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The prescription of polypharmacy, cardiovascular medications, and psychotropic and dopaminergic drugs increases the risk of syncope and falls.
“The prescription of polypharmacy, cardiovascular medications, and psychotropic (neuroleptics and antidepressants) and dopaminergic drugs also increases the risk of syncope and falls. 381-385”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [384]
Syncope related to medication becomes prevalent particularly in older adults.
“Syncope related to medication becomes prevalent particularly in older adults, who frequently have multiple comorbidities requiring treatment and are prone to polypharmacy effects (488–490).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [489]
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2018 ESC Guidelines for the diagnosis and management of syncope
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- Authors
- McLachlan, C. Y. L., Yi, M., Ling, A., & Jardine, D. L.
- Affiliations
- Christchurch Hospital (NZ)
- Canterbury District Health Board (NZ)
- Medical Corner Doctors Rangiora New Zealand
- Corresponding author
- McLachlan, C. Y. L.
- ORCID
- Jardine, D. L.
- Venue
- Internal Medicine Journal
- Publisher
- Wiley
- Published
- 2014-07
- Volume
- 44
- Issue
- 7
- Pages
- 633-638
- ISSN
- 1444-0903 (ISSN-L)
- 1445-5994
- OpenAlex
- W2146247365
- Cited by
- 44
- References
- 24
- Citations by year
- 2026: 3 · 2024: 2 · 2023: 2 · 2022: 7 · 2021: 4 · 2020: 7 · 2019: 2 · 2018: 8 · 2017: 6 · 2016: 3
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Internal Medicine Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- adverse drug reactions, hospitalization, acute medical admissions, orthostatic hypotension, vasovagal syncope, intentional drug overdose, recreational drug use, acute kidney injury, dehydration, polypharmacy
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Follow-Up Studies, Humans, Hypotension, Orthostatic, Male, Middle Aged, New Zealand, Patient Admission, Prospective Studies, Syncope, Vasovagal, Young Adult, Drug-Related Side Effects and Adverse Reactions
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