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Hospitalizations due to preventable adverse reactions—a systematic review

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Abstract

Purpose

The study aimed to measure the percentage of preventable adverse drug reactions that lead to the hospitalization (PADRAd) and to explore the heterogeneity in its estimation through subgroup analysis of study characteristics.

Methods

Two investigators independently searched in electronic databases and related bibliography for prospective studies involving PADRAd. We excluded studies investigating medication errors and spontaneous and retrospective reporting. The primary outcome was PADRAd percentage. To explore the heterogeneity, we performed subgroup analysis based on study region, wards, age groups, adverse drug reaction (ADR) definitions, preventability assessment, ADR identification methods, study duration and sample size. We explored fatal PADRAd and causative drugs as a secondary outcome. We used the generic inverse variance method with random effect model to compute meta-analytic summary.

Results

Of the 68 full-text articles assessed, we included 22 studies. The mean PADRAd percentage was 45.11 % (95 % CI = 33.06–57.15; I 2 = 99 %). Studies including elderly (63.31 %) and all age groups (49.03 %) showed higher percentages than paediatric population (16.40 %). Studies examining all hospital populations showed higher percentages than specific wards. We observed high percentages in studies using Edwards and Aronson as an ADR definition and Hallas et al. as a preventability assessment tool. After age group adjustment, ADR detection methods did not show significant difference. The fatal PADRAd percentage was 1.58 % (95 % CI = −0.60 to 3.76; I 2 = 47 %). Paediatric and elderly studies showed a different causative drug pattern.

Conclusion

Variation in PADRAd across the studies can be explained by difference in study populations and data collection methods. Extrapolation of preventable reactions should be carried out considering all these factors with caution.

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Authors and Affiliations

  1. Department of Pharmacology, Government Medical College, Bhavnagar, Gujarat, 364001, India

    Nidhi S. Patel, Viren N. Naik & CB Tripathi

  2. Sir Takhtsinhji General Hospital, Bhavnagar, Gujarat, 364001, India

    Nidhi S. Patel, Viren N. Naik & CB Tripathi

  3. Department of Pharmacology, GMERS Medical College, Gotri, Vadodara, Gujarat, 390021, India

    Tejas K. Patel & Parvati B. Patel

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  1. Nidhi S. Patel
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Correspondence to Tejas K. Patel.

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Supplementary Fig. 1

Meta-analytic summary of prevalence of PADRAd. Abbreviation is as follows: PADR Ad preventable ADRs resulting in hospital admission. (JPEG 685 kb)

Supplementary Fig. 2

Meta-analytic summary of subgroup analysis of percentage of PADRAd in paediatric patients for ADR definition and preventability assessment tool. Abbreviation is as follows: PADR Ad preventable ADRs resulting in hospital admission. (JPEG 592 kb)

Supplementary Fig. 3

Meta-analytic summary of subgroup analysis of percentage of PADRAd according to study region. Abbreviation is as follows: PADR Ad preventable ADRs resulting in hospital admission. (JPEG 3014 kb)

Supplementary Fig. 4

Meta-analytic summary of subgroup analysis of percentage of PADRAd according to ADR definition. Abbreviation is as follows: PADR Ad preventable ADRs resulting in hospital admission. (JPEG 2978 kb)

Supplementary Fig. 5

Meta-analytic summary of subgroup analysis of percentage of PADRAd according to ADR identification method. Abbreviation is as follows: PADR Ad preventable ADRs resulting in hospital admission. (JPEG 2797 kb)

Supplementary Fig. 6

Meta-analytic summary of fatal ADRAd and preventable fatal ADRAd. (JPEG 1169 kb)

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Patel, N.S., Patel, T.K., Patel, P.B. et al. Hospitalizations due to preventable adverse reactions—a systematic review. Eur J Clin Pharmacol 73, 385–398 (2017). https://doi.org/10.1007/s00228-016-2170-6

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  • DOI: https://doi.org/10.1007/s00228-016-2170-6

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