Elsevier

Pharmacological Research

Volume 50, Issue 6, December 2004, Pages 631-636
Pharmacological Research

Adverse drug events in two emergency departments in Naples, Italy: an observational study

https://doi.org/10.1016/j.phrs.2004.05.008Get rights and content

Abstract

The aims of this study, conducted in the emergency departments of two hospitals of Naples (Italy), which differ in type of catchment area and in the number of daily visits, were to determine: (1) the percent of emergency department visits due to adverse drug events (ADEs); (2) the percent of visits requiring hospitalisation due to acute ADEs; (3) the drugs implicated in ADEs; and (4) the types of ADEs and their frequency. We studied all emergency department visits at the A. Cardarelli and Incurabili hospitals between 8.00 a.m. and 8.00 p.m. (prospectively), and between 8.00 p.m. and 8.00 a.m. (retrospectively) for two 10-day periods. When possible, a form was completed for each subject. Patients were asked if they had taken a drug (name, dosage and reason for its use) in the previous 2 weeks. Of the 2442 emergency visits considered, 34 (1.3%) were drug related. Of the 480 patients who were subsequently hospitalised 17 (3.6%) had an ADE. The number increased to 34 (8.9%) in the 379 patients who took drugs in the 2 previous weeks. Non-steroidal anti-inflammatory drugs accounted for 26.5% of cases, antibiotics 23.6%, and antihypertensive agents 17.7%. The most frequent ADEs were gastrointestinal diseases (diarrhea, vomiting and haemorrhagic gastritis) and cutaneous rash (erythema, dermatitis). This study shows that ADEs account for a large percent of hospital admissions and confirms that drug-induced disorders is a notable public health problem.

Introduction

Adverse drug events (ADEs) are an important challenge in modern medicine. They have a considerable negative impact on both health and healthcare costs [1], and their incidence has been reported to range from 5.9 to 22.3% of all emergency department admissions [2]. Adverse drug reactions have been shown to prolong hospitalisation by 1 and 7 days, respectively, in 6 and 12% patients affected by common diseases [3], [4]. In a general medicine department, pharmacological therapy had to be prolonged in 3.8% of hospitalised patients because of ADEs and 5% of these patients had life-threatening ADEs [4]. Monitoring of emergency department visits is a well-established method with which to evaluate the frequency of ADE-related hospital admission [5], [6], [7], [8], [9], [10]. The Italian Society of Pharmacology and the Epidemiological and Biostatistics Laboratory of the Istituto Superiore di Sanità promoted an observational epidemiologic study of ADEs in 24 emergency departments in Italy. The aims of the project were to evaluate: (1) the number of visits to emergency departments due to ADEs; (2) the percentage of hospital admissions due to acute ADEs; (3) the drug classes most frequently involved in ADEs; (4) the types of ADEs and their frequency. Here we report the results obtained in the emergency departments of the A. Cardarelli and Incurabili hospitals in Naples, which have about 100,000 and 25,000 emergency room visits, respectively, a year. The Cardarelli Emergency Department is constituted by various clinical and surgical units, including the following specialties: ENT, ophthalmology, and a severe burns centre; its catchment area is Naples and all southern Italy regions. The Incurabili Emergency Department is constituted by only two units (surgery and clinics), and it serves people living in the vicinity of the hospital.

Section snippets

Materials and methods

The A. Cardarelli and Incurabili hospitals were selected for this study because they serve different catchment areas and differ in the number of daily emergency department visits.

The two surveys were carried out in different periods of the year (from February 28 to March 8, and from June 19 to June 28, 2000) to ascertain if seasonal disorders (i.e. exacerbation of chronic bronchitis or allergic asthma) could affect the number and the kind of ADEs versus chronic disease (i.e. hypertension,

Limitations

Intra- and inter-rater agreement tests were not performed during the intensive course on theoretical and practical aspects of pharmacovigilance in emergency departments. Because of missing clinical data, 240 patients at the Cardarelli hospital were not evaluated; anyway there were not significant age, sex, or race differences between these subjects and the subjects evaluated.

Results

As shown in Table 1, in the first 10-day period of the survey (survey 1), there were 1311 emergency room visits at the A. Cardarelli hospital. Data were collected for 1049 patients (80%); 915 of these (87.3%) were day visits and 134 (12.7%) night visits. A total of 827 (78.7%) patients were admitted to general medicine, 178 (16.9%) to orthopaedics, 18 (2.0%) to ophthalmology, and 26 (2.4%) to otolaryngology. A total of 228 patients (21.7%) had taken medication in the 2 weeks before the study.

Of

Discussion

No drug is completely harmless, even when used correctly, and all may cause ADEs [1], [2], [3]. As the number of drugs increase, methods must be found to detect more rapidly peculiar and previously unrecognised deleterious consequences of therapy. In addition, epidemiological investigations of drug usage and untoward reactions are necessary to establish means to prevent adverse consequences [4], [12], [13].

Our observational study confirms that ADEs significantly affect hospital admission rate.

Acknowledgements

The following emergency department physicians participated in this study: Nicola Armogida (MD, Incurabili hospital), Vittorio Russo (MD, A. Cardarelli hospital). We are grateful to Jean Gilder—Scientific Communication for text editing.

References (20)

  • R. Rodriguez-Monguio et al.

    Assessing the economic impact of adverse drug effects

    Pharmacoeconomics

    (2003)
  • K.M. Nelson et al.

    Drug-related hospital admissions

    Pharmacotherapy

    (1996)
  • R. Raschetti et al.

    Suspected adverse drug events requiring emergency department visits or hospital admission

    Eur. J. Clin. Pharmacol

    (1999)
  • N. Moore et al.

    Frequency and cost of serious adverse drug reactions in to department of general medicines

    Br. J. Clin. Pharmacol

    (1998)
  • K.J. Belton

    The European Pharmacovigilance Research Group. Attitude survey of adverse-drug reaction reporting by health expensive professionals across the European Union. European

    J. Clin. Pharmacol

    (1997)
  • L.L. Leape et al.

    The natures of adverse drug events in hospitalized patients: results from the Harvard Medical Practice Study II

    N. Engl. J. Med

    (1991)
  • M.J. Tafreshi et al.

    Medication-related visits to the emergency department: a prospective study

    Ann. Pharmacother

    (1999)
  • D.C. Classen et al.

    Adverse drug events in hospitalized patients. Excess length of stay, extra costs and attributable mortality

    JAMA

    (1997)
  • P.J. McDonnell et al.

    Hospital admissions resulting from preventable adverse drug reactions

    Ann. Pharmacother

    (2002)
  • P. Patel et al.

    Drug-related visits to the emergency department: how big is the problem?

    Pharmacotherapy

    (2002)
There are more references available in the full text version of this article.

Cited by (0)

View full text