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  • Title: Life-threatening adverse drug reactions at admission to medical intensive care: a prospective study in a teaching hospital.
    Author: Grenouillet-Delacre M, Verdoux H, Moore N, Haramburu F, Miremont-Salamé G, Etienne G, Robinson P, Gruson D, Hilbert G, Gabinski C, Bégaud B, Molimard M.
    Journal: Intensive Care Med; 2007 Dec; 33(12):2150-7. PubMed ID: 17653528.
    Abstract:
    OBJECTIVE: To assess the characteristics of life-threatening adverse drug reactions in patients admitted to medical intensive care unit and to define those that could facilitate early identification. DESIGN: A prospective 6-month observational study. PATIENTS: Of the 436 admissions to the teaching hospital medical intensive care unit, all patients aged over 15 years and who had received documented drug treatment were included (n = 405). MEASUREMENTS: Characteristics of patients [age, gender, underlying diseases, organ failure(s), drugs taken, Severity Acute Physiologic Score II, length of stay, outcome at discharge] were prospectively collected using a standardised questionnaire. A panel of experts assessed putative serious adverse drug reaction(s) for each drug taken and each organ failure at admission by using a standardised causality assessment method. Characteristics of patients with and without serious adverse drug reactions at admission were compared using univariate and then stepwise descending multivariate logistic regression. RESULTS: Of the 405 patients included, 111 (27.4%) presented an adverse drug reaction leading to organ failure. In 48% of cases adverse drug reactions were preventable, 23% were undiagnosed and 19% contributed to death. Age over 75 years [odds ratio (OR) 2.25; 95% confidence interval (CI) 1.15-4.38; p = 0.02], having more than three drugs (OR 6.90; 95% CI 1.44-33.00; p = 0.02) and a diagnosis of haematological malignancy (OR 6.19; 95% CI 2.07-18.53; p = 0.001) were independently associated with serious adverse drug reactions. CONCLUSIONS: Preventable life-threatening adverse drug reactions were frequently involved in organ failure at admission to medical intensive care; many of them had not been identified.
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