[Iatrogenic illness observed in the hospital environment. I. A report of 109 cases collected in a cross-sectional APNET study].

In an "on a given day" study, we analysed the prevalence and causes of drug-related and non-drug-related iatrogenic illnesses for educational and preventive purposes. Forty-three hospital departments of various specialties and involving 62 APNET members participated in the study. From a total of 112 cases reported, 109 were considered iatrogenic illnesses on the basis of the French criteria for adverse effects. Four major types of iatrogenic illness were defined, as follows: I--drug-related cases (n = 83); II--miscellaneous cases (n = 6); III--cases due to therapeutic instrumentation (n = 16); IV--cases due to diagnostic instrumentation (n = 4). Overall, 6.28% of the patients admitted presented an iatrogenic illness; 67 (61.46%) of the 109 cases concerned women and 66 (60.55%) concerned patients aged 65 years or more. The types of illness in the "drug-induced" and "miscellaneous" categories were endocrine and metabolic disturbances (n = 14), gastrointestinal conditions (n = 13) and hematological disorders (11 cases of bone marrow aplasia). Instrument-related iatrogenic illnesses comprised cardiovascular conditions (n = 6), locoregional anatomic lesions (n = 5), infectious complications (n = 3), bleeding (n = 3) and others (n = 3). Seventeen incidents were benign, 38 dangerous and 51 serious; there were three deaths. The main drug categories concerned in the 89 cases of "drug-related" and "miscellaneous" iatrogenic illnesses were as follows: cardiovascular agents (n = 20), antiinflammatory and analgesic drugs (n = 18), hormone and nutritional treatments (n = 11) and neuropsychiatric drugs (n = 11). Instrument-related iatrogenic illnesses chiefly involved venous approaches (n = 8), surgery (n = 4), intensive care procedures (n = 2), renal dialysis (n = 2) and radiation therapy (n = 2). The main causes of drug-related iatrogenic illnesses were self-treatment (n = 8), poor compliance (n = 8), and therapeutic errors (n = 27) [non-respect of a contraindication (n = 2), wrong indication (n = 6), excessive dose (n = 13), over-prolonged treatment (n = 2) and other errors (n = 4). A cost-analysis of 74 of the 109 cases gave a minimum figure of 2 million French francs. The human and financial costs of iatrogenic illnesses show that risk-prevention measures are required; these will be dealt with in a later paper, but should be based on stricter regulations and educational programmes aimed at doctors, patients, the general public, the pharmaceutical industry and the health authorities.