Brvar Miran, Fokter Nina, Bunc Matjaz, Mozina Martin
Poison Control Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia.
BMC Clin Pharmacol. 2009 May 4;9:8. doi: 10.1186/1472-6904-9-8.
Adverse Drug Reactions (ADRs) have been regarded as a major public health problem since they represent a sizable percentage of admissions. Unfortunately, there is a wide variation of ADR related admissions among different studies. The aim of this study was to evaluate the frequency of ADR related admissions and its dependency on reporting and method of detection, urgency of admissions and included medical departments reflecting department/hospital type within one study.
The study team of internal medicine specialists retrospectively reviewed 520 randomly selected medical records (3%) of patients treated in the medical departments of the primary city and tertiary referral governmental hospital for certain ADRs causing admissions regarding WHO causality criteria. All medical records were checked for whether the treating physicians recognised and documented ADRs causing admissions. The hospital information system was checked to ensure ADR related diagnoses were properly coded and the database of a national spontaneous reporting system was searched for patients with ADRs included in this study.
The established frequency of admissions due to certain ADRs recognised by the study team and documented in medical records by the treating physicians was the same and represented 5.8% of all patients (30/520). The frequency of ADR causing admissions detected by employing a computer-assisted approach using an ICD-10 coding system was 0.2% (1/520), and no patient admitted due to ADRs was reported to the national reporting system (0/520). The recognized frequency of ADR related admissions also depends on the department's specialty (p = 0.001) and acceptance of urgently admitted patients (p = 0.001). Patients admitted due to ADRs were significantly older compared to patients without ADRs (p = 0.025). Gastrointestinal bleeding due to NSAID, acetylsalicylic acid and warfarin was the most common ADR that resulted in admission and represented 40% of all certain ADRs (12/30) according to WHO causality criteria.
ADRs cause 5.8% of admissions in medical departments in the primary city and tertiary referral hospital. The physicians recognise certain ADR related admissions according to WHO causality criteria and note them in medical records, but they rarely code and report ADRs. The established frequency of ADR related admissions depends on the detection method, department specialty and frequency of urgently admitted patients.
药物不良反应（ADR）一直被视为一个重大的公共卫生问题，因为它们在住院病例中占相当大的比例。不幸的是，不同研究中与ADR相关的住院病例差异很大。本研究的目的是评估在一项研究中，与ADR相关的住院频率及其对报告和检测方法、住院紧迫性以及所涉医学科室（反映科室/医院类型）的依赖性。
内科专家研究团队回顾性审查了从主要城市的公立医院和三级转诊公立医院的医学科室中随机选取的520份病历（3%），这些病历涉及因某些ADR导致住院的病例，并依据世界卫生组织因果关系标准进行评估。检查所有病历，以确定治疗医生是否识别并记录了导致住院的ADR。检查医院信息系统，以确保与ADR相关的诊断得到正确编码，并在国家自发报告系统的数据库中搜索本研究中包含的ADR患者。
研究团队确定的、治疗医生在病历中记录的因某些ADR导致的住院频率相同，占所有患者的5.8%（30/520）。采用ICD - 10编码系统的计算机辅助方法检测到的因ADR导致住院的频率为0.2%（1/520），且没有因ADR住院的患者被报告至国家报告系统（0/520）。所识别的与ADR相关的住院频率还取决于科室专业（p = 0.001）和对急诊入院患者的接纳情况（p = 0.001）。与无ADR的患者相比，因ADR住院的患者年龄显著更大（p = 0.025）。根据世界卫生组织因果关系标准，因非甾体抗炎药、乙酰水杨酸和华法林导致的胃肠道出血是最常见的导致住院的ADR，占所有特定ADR的40%（12/30）。
在主要城市的公立医院和三级转诊医院的医学科室中，ADR导致5.8%的住院病例。医生根据世界卫生组织因果关系标准识别某些与ADR相关的住院病例并在病历中记录，但他们很少对ADR进行编码和报告。所确定的与ADR相关的住院频率取决于检测方法、科室专业和急诊入院患者的频率。
