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Drug-Related Deaths in a Department of Internal Medicine  
 
 
  Just Ebbesen, MD; Ingebjørg Buajordet, MSc; Jan Erikssen, MD, PhD; Odd Brørs, MD, PhD; Thor Hilberg, MD, PhD; Helge Svaar, MD; Leiv Sandvik, MSc, PhD

Background  Drug therapy is associated with adverse effects, and fatal adverse drug events (ADEs) have become major hospital problems. Our study assesses the incidence of fatal ADEs in a major medical department and identifies possible patient characteristics signifying fatal ADE risk.

Methods  During a 2-year period, a multidisciplinary study group examined all 732 patients who died5.2% of the 13 992 patients admitted to the Department of Internal Medicine, Central Hospital of Akershus, Nordbyhagen, Norway. Decisions about the presence or absence of fatal ADEs were based on aggregated clinical records, autopsy results, and findings from premortem and postmortem drug analyses.

Results  In 18.2% of the patients (133/732) (95% confidence interval, 15.4%-21.0%), deaths were classified as being directly (64 [48.1%] of 133) or indirectly (69 [51.9%] of 133) associated with 1 or more drugs (this equals 9.5 deaths per 1000 hospitalized patients). Those with fatal ADEs (cases) were older, had more diseases, and used more drugs than those without fatal ADEs (noncases). In 75 of the 133 patients with fatal ADEs, autopsy findings and/or drug analysis data were decisive for recognizing the ADEs; in 62 of the remaining 595 patients, similar data proved necessary to exclude the suspicion of a fatal ADE. Major culprit drugs were cardiovascular, antithrombotic, and sympathomimetic agents.

Conclusions  Fatal ADEs represent a major hospital problem, especially in elderly patients with multiple diseases. A higher number of drugs administered was associated with a higher frequency of fatal ADEs, but whether a high number of drugs is an independent risk factor for fatal ADEs is unsettled. Autopsy results and the findings of premortem and postmortem drug analyses were important for recognizing and excluding suspected fatal ADEs.

Arch Intern Med. 2001;161:2317-2323

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From the Foundation for Health Services Research (Drs Ebbesen and Sandvik) and the Departments of Internal Medicine (Dr Erikssen) and Pathology (Dr Svaar), Central Hospital of Akershus, Nordbyhagen, Norway; and the Norwegian Medicines Control Authority (Ms Buajordet), the Division of Clinical Pharmacology and Toxicology, Clinical Chemistry Department, Ullevaal University Hospital (Dr Brørs), and the National Institute of Forensic Toxicology (Dr Hilberg), Oslo, Norway.
 
Corresponding author and reprints: Just Ebbesen, MD, Foundation for Health Services Research, Central Hospital of Akershus, N-1474 Nordbyhagen, Norway (e-mail: justebbe@online.no).

Accepted for publication March 13, 2001.

This study was supported by The Fund for Quality Improvement in Hospitals from the Norwegian Medical Association, Oslo; by the Norwegian Medicinal Depot ASA, Oslo; and the Fund for Research and Development from the Central Hospital of Akershus.

We thank all staff at participating departments (inside and outside of Central Hospital of Akershus) for their positive attitude and cooperation and our employers for giving us time to analyze and finish the project.

 

 
© 2001 American Medical Association. All rights reserved.