Rahim Sherali A, Mody Anita, Pickering Jennifer, Devereaux P J, Yusuf Salim
Division of Cardiology, Department of Medicine, and the Cardiac and Vascular Program, McMaster University, Hamilton, Ontario, Canada.
Circ Cardiovasc Qual Outcomes. 2009 Sep;2(5):437-42. doi: 10.1161/CIRCOUTCOMES.108.846493. Epub 2009 Aug 18.
Although our understanding of medical adverse events has increased substantially over the last decade, little is known about iatrogenic adverse events (IAEs) in the coronary care unit (CCU). We sought to determine the frequency and potential preventability of IAEs in the CCU of a tertiary care center.
We undertook a retrospective cohort study evaluating the hospital charts of consecutive patients admitted to the CCU at Hamilton General Hospital (Ontario, Canada) from November 1, 2005, to January 1, 2006. We used a priori developed definitions to determine whether patients suffered an IAE and whether it was potentially preventable. We included 194 patients, and 99 (51%; 95% CI, 44% to 58%) patients had at least 1 IAE, of which 45 (45%; 95% CI, 36% to 55%) were judged potentially preventable. Bleeding (14/51, 27%; 95% CI, 17% to 41%) was the most common potentially preventable IAE and was more common than recurrent ischemic events (4/51, 8%; 95% CI, 3% to 19%). Of the patients who died in the hospital, 9 of 17 (53%; 95% CI, 31% to 74%) had an IAE that was causally related to their death, of which 6 (67%; 95% CI, 35% to 88%) were judged potentially preventable.
The present study suggests that IAEs, especially bleeding, are common in the CCU setting and more frequent than recurrent ischemic events. These results suggest the need for large multicenter studies to evaluate in CCUs the rates of IAEs, their causes, and potential preventability.
尽管在过去十年中我们对医疗不良事件的理解有了大幅提高，但对于冠心病监护病房（CCU）中的医源性不良事件（IAEs）却知之甚少。我们试图确定三级医疗中心CCU中医源性不良事件的发生率及潜在可预防性。
我们进行了一项回顾性队列研究，评估了2005年11月1日至2006年1月1日期间加拿大安大略省汉密尔顿综合医院CCU连续收治患者的医院病历。我们使用预先制定的定义来确定患者是否发生了医源性不良事件以及该事件是否具有潜在可预防性。我们纳入了194例患者，其中99例（51%；95%可信区间[CI]，44%至58%）至少发生了1次医源性不良事件，其中45例（45%；95%CI，36%至55%）被判定为潜在可预防。出血（14/51，27%；95%CI，17%至41%）是最常见的潜在可预防医源性不良事件，比复发性缺血事件（4/51，8%；95%CI，3%至19%）更常见。在院内死亡的患者中，17例中有9例（53%；95%CI，31%至74%）发生了与死亡有因果关系的医源性不良事件，其中6例（67%；95%CI，35%至88%）被判定为潜在可预防。
本研究表明，医源性不良事件，尤其是出血，在CCU环境中很常见，且比复发性缺血事件更频繁。这些结果表明需要进行大型多中心研究，以评估CCU中医源性不良事件的发生率、原因及潜在可预防性。
