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Drug-related admissions and hospital-acquired adverse drug events in Germany: a longitudinal analysis from 2003 to 2007 of ICD-10-coded routine data.

Stausberg J, Hasford J - BMC Health Serv Res (2011)

Bottom Line: Among all hospital admissions, 5% were found to be at least possibly drug-induced and 0.7% very likely drug-induced.Between 2003 and 2007, there was a statistically significant increase in the overall rate and in some of the subcategories defined by the list of ICD-10-codes suspected to be indicative of an ADE.Before the use of routine data in pharmacovigilance and patient safety can be fully exploited, a further tailoring of both the ICD and the available variable set is needed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, Marchioninistraße 15, D-81377 München, Germany. juergen.stausberg@ibe.med.uni-muenchen.de

ABSTRACT

Background: Adverse reactions and medication errors are complications of drug use. Spontaneous reporting systems and pharmacoepidemiological studies incompletely detect the occurrence of these events in daily hospital care. In this study, the frequency and type of drug-related admissions and hospital-acquired adverse drug events (ADE) in Germany were assessed using routinely collected hospital data.

Methods: The study was based on aggregated hospital routine data covering the period 2003 to 2007 and annually recorded as part of the further development of the German Diagnosis-Related Groups. The 505 ICD-10-codes indicating an ADE were categorized in seven groups according to their certainty. Primary diagnoses were considered as a proxy for drug-related admissions, and secondary diagnoses as a proxy for hospital-acquired ADE.

Results: Among all hospital admissions, 5% were found to be at least possibly drug-induced and 0.7% very likely drug-induced. There was a significant increase in the overall rate of drug-related admissions over time (p < 0.038). Enterocolitis due to Clostridium difficile infection was the most frequent cause of a drug-related admission. About 4.5% of in-patients had experienced a hospital-acquired ADE. In addition, over the course of the study period, the overall frequency of hospital-acquired ADEs significantly increased (p < 0.001).

Conclusions: In Germany, more than 5% of hospital episodes are either caused or complicated by an ADE. Between 2003 and 2007, there was a statistically significant increase in the overall rate and in some of the subcategories defined by the list of ICD-10-codes suspected to be indicative of an ADE. Before the use of routine data in pharmacovigilance and patient safety can be fully exploited, a further tailoring of both the ICD and the available variable set is needed.

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Related in: MedlinePlus

Average annual rates of adverse drug events (ADEs) in the seven categories (left, gray column: drug-related admissions; right, black column: hospital-acquired).
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Figure 1: Average annual rates of adverse drug events (ADEs) in the seven categories (left, gray column: drug-related admissions; right, black column: hospital-acquired).

Mentions: About 48 million hospital episodes were included in this analysis of ADEs. From 2003 to 2006, the InEK sheets covered between 11,205,770 and 11,978,011 hospital episodes (Table 2), representing between 72% (2003) and 79% (2006) of all episodes recorded with the G-DRG system. The 10% sample of hospitals in 2007 consisted of 1,964,313 episodes (13% of all episodes in 2007). Figure 1 shows the averages of the annual ADE rates in the seven categories.


Drug-related admissions and hospital-acquired adverse drug events in Germany: a longitudinal analysis from 2003 to 2007 of ICD-10-coded routine data.

Stausberg J, Hasford J - BMC Health Serv Res (2011)

Average annual rates of adverse drug events (ADEs) in the seven categories (left, gray column: drug-related admissions; right, black column: hospital-acquired).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3116475&req=5

Figure 1: Average annual rates of adverse drug events (ADEs) in the seven categories (left, gray column: drug-related admissions; right, black column: hospital-acquired).
Mentions: About 48 million hospital episodes were included in this analysis of ADEs. From 2003 to 2006, the InEK sheets covered between 11,205,770 and 11,978,011 hospital episodes (Table 2), representing between 72% (2003) and 79% (2006) of all episodes recorded with the G-DRG system. The 10% sample of hospitals in 2007 consisted of 1,964,313 episodes (13% of all episodes in 2007). Figure 1 shows the averages of the annual ADE rates in the seven categories.

Bottom Line: Among all hospital admissions, 5% were found to be at least possibly drug-induced and 0.7% very likely drug-induced.Between 2003 and 2007, there was a statistically significant increase in the overall rate and in some of the subcategories defined by the list of ICD-10-codes suspected to be indicative of an ADE.Before the use of routine data in pharmacovigilance and patient safety can be fully exploited, a further tailoring of both the ICD and the available variable set is needed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, Marchioninistraße 15, D-81377 München, Germany. juergen.stausberg@ibe.med.uni-muenchen.de

ABSTRACT

Background: Adverse reactions and medication errors are complications of drug use. Spontaneous reporting systems and pharmacoepidemiological studies incompletely detect the occurrence of these events in daily hospital care. In this study, the frequency and type of drug-related admissions and hospital-acquired adverse drug events (ADE) in Germany were assessed using routinely collected hospital data.

Methods: The study was based on aggregated hospital routine data covering the period 2003 to 2007 and annually recorded as part of the further development of the German Diagnosis-Related Groups. The 505 ICD-10-codes indicating an ADE were categorized in seven groups according to their certainty. Primary diagnoses were considered as a proxy for drug-related admissions, and secondary diagnoses as a proxy for hospital-acquired ADE.

Results: Among all hospital admissions, 5% were found to be at least possibly drug-induced and 0.7% very likely drug-induced. There was a significant increase in the overall rate of drug-related admissions over time (p < 0.038). Enterocolitis due to Clostridium difficile infection was the most frequent cause of a drug-related admission. About 4.5% of in-patients had experienced a hospital-acquired ADE. In addition, over the course of the study period, the overall frequency of hospital-acquired ADEs significantly increased (p < 0.001).

Conclusions: In Germany, more than 5% of hospital episodes are either caused or complicated by an ADE. Between 2003 and 2007, there was a statistically significant increase in the overall rate and in some of the subcategories defined by the list of ICD-10-codes suspected to be indicative of an ADE. Before the use of routine data in pharmacovigilance and patient safety can be fully exploited, a further tailoring of both the ICD and the available variable set is needed.

Show MeSH
Related in: MedlinePlus