Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients

doi:10.1136/bmj.329.7456.15

BMJ 2004;329:15-19 (3 July), doi:10.1136/bmj.329.7456.15

Paper

Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients

Munir Pirmohamed, professor of clinical pharmacology¹, Sally James, research pharmacist³, Shaun Meakin, research nurse², Chris Green, senior pharmacist², Andrew K Scott, consultant in care of the elderly³, Thomas J Walley, professor of clinical pharmacology¹, Keith Farrar, chief pharmacist³, B Kevin Park, professor of pharmacology¹, Alasdair M Breckenridge, professor of clinical pharmacology¹

¹ Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool L69 3GE, ² Royal Liverpool University Hospital, Liverpool L7 8XP, ³ Wirral Hospitals NHS Trust, Wirral CH49 5PE

Correspondence to: M Pirmohamed munirp{at}liv.ac.uk

Objective To ascertain the current burden of adverse drug reactions(ADRs) through a prospective analysis of all admissions to hospital.

Design Prospective observational study.

Setting Two large general hospitals in Merseyside, England.

Participants 18 820 patients aged > 16 years admitted oversix months and assessed for cause of admission.

Main outcome measures Prevalence of admissions due to an ADR,length of stay, avoidability, and outcome.

Results There were 1225 admissions related to an ADR, givinga prevalence of 6.5%, with the ADR directly leading to the admissionin 80% of cases. The median bed stay was eight days, accountingfor 4% of the hospital bed capacity. The projected annual costof such admissions to the NHS is £466m ( ${euro}$ 706m, $847m).The overall fatality was 0.15%. Most reactions were either definitelyor possibly avoidable. Drugs most commonly implicated in causingthese admissions included low dose aspirin, diuretics, warfarin,and non-steroidal anti-inflammatory drugs other than aspirin,the most common reaction being gastrointestinal bleeding.

Conclusion The burden of ADRs on the NHS is high, accountingfor considerable morbidity, mortality, and extra costs. Althoughmany of the implicated drugs have proved benefit, measures needto be put into place to reduce the burden of ADRs and therebyfurther improve the benefit:harm ratio of the drugs.

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Rapid Responses:

Read all Rapid Responses

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Another view from General Practice: L Sam Lewis
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