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Intensive Care Medicine

, Volume 35, Issue 2, pp 266–274 | Cite as

Adverse drug reactions and deliberate self-poisoning as cause of admission to the intensive care unit: a 1-year prospective observational cohort study

  • Lukas Schwake
  • Ines Wollenschläger
  • Wolfgang Stremmel
  • Jens Encke
Original

Abstract

Objective

The aim of the present study was (1) to determine the prevalence of intensive care unit (ICU) admissions due to an adverse drug reaction (ADR), and (2) to compare affected patients with patients admitted to the ICU for the treatment of deliberate self-poisoning using medical drugs.

Design

Prospective observational cohort study.

Setting

Fourteen bed medical ICU including an integrated intermediate care (IMC) section at a tertiary referral center.

Patients

A total of 1,554 patients admitted on 1 January 2003 to 31 December 2003.

Results

Ninety-nine patients were admitted to the ICU with a diagnosis of ADR (6.4% of all admissions), 269 admissions (17.3%) were caused by deliberate self-poisoning. Patients admitted for treatment of ADR had a significantly higher age, a longer treatment duration in the ICU, a higher SAPS II score, and a higher 6-month mortality than those with deliberate self-poisoning. Most patients (71.7%) suffering from ADR required advanced supportive care in the ICU while the majority of patients (90.7%) with deliberate self-poisoning could be sufficiently treated in the IMC area. All diagnostic and therapeutic procedures in the ICU except mechanical ventilation were significantly more often performed in patients with ADR.

Conclusions

This study provides further evidence that ADR is a frequent cause of admission to medical ICUs resulting in a considerable use of ICU capacities. In the present setting patients with ADR required longer and more intense medical treatment in the ICU than those with deliberate self-poisoning.

Keywords

Adverse drug reaction Intoxication Self-poisoning Intensive care unit 

References

  1. 1.
    Kaufmann DW, Shapiro S (2000) Epidemiological assessment of drug-induced disease. Lancet 356:1339–1343CrossRefGoogle Scholar
  2. 2.
    Edwards IR, Aronson JK (2000) Adverse drug reactions: definitions, diagnosis and management. Lancet 356:1255–1259PubMedCrossRefGoogle Scholar
  3. 3.
    Lazarou J, Pomeranz B, Corey P (1998) Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 279:1200–1205PubMedCrossRefGoogle Scholar
  4. 4.
    Kelly WN (2001) Can the frequency and risks of fatal adverse drug events be determined? Pharmacotherapy 21:521–527PubMedCrossRefGoogle Scholar
  5. 5.
    Bond CA, Raehl CL (2006) Adverse drug reactions in United States Hospitals. Pharmacotherapy 26:601–608PubMedCrossRefGoogle Scholar
  6. 6.
    Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18820 patients. BMJ 329:15–19PubMedCrossRefGoogle Scholar
  7. 7.
    Dormann H, Neubert A, Criegee-Rieck M, Egger T, Radespiel-Tröger M, Azaz-Livshits T, Levy M, Brune K, Hahn EG (2004) Readmissions and adverse drug reactions in internal medicine: the economic impact. J Intern Med 255:653–663PubMedCrossRefGoogle Scholar
  8. 8.
    Trunet P, Le Gall JR, Lhoste F, Regnier B, Saillard Y, Carlet J, Rapin M (1980) The role of iatrogenic disease in admissions to intensive care. JAMA 244:2617–2620PubMedCrossRefGoogle Scholar
  9. 9.
    Farina ML, Tognoni G, Procaccio F (1987) Epidemiology of adverse drug reactions in intensive care unit. Arch Intern Med 159:71–78Google Scholar
  10. 10.
    Darchy B, Le Miere E, Figuredo B, Bavoux E, Domart Y (1999) Iatrogenic diseases as a reason for admission to the intensive care unit: incidence, causes, and consequences. Arch Intern Med 159:71–78PubMedCrossRefGoogle Scholar
  11. 11.
    Lehmann LS, Puopolo AL, Shaykevich S, Brennan TA (2005) Iatrogenic events resulting in intensive care admission: frequency, cause, and disclosure to patients and institutions. Am J Med 118:409–413PubMedCrossRefGoogle Scholar
  12. 12.
    Grenouillet-Delacre M, Verdoux H, Moore N, Haramburu F, Miremont-Salame G, Etienne G, Robinson P, Gruson D, Hilbert G, Gabinski C, Begaud B, Molimard M (2007) Life-threatening adverse drug reactions at admission to medical intensive care: a prospective study in a teaching hospital. Int Care Med 33:2150–2157CrossRefGoogle Scholar
  13. 13.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new acute simplified score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRefGoogle Scholar
  14. 14.
    Somers A, Petrovic M, Robays H, Bogaert M (2003) Reporting adverse drug reactions on a geriatric ward: a pilot project. Eur J Clin Pharmacol 58:707–714PubMedGoogle Scholar
  15. 15.
    Ramesh M, Pandit J, Parthasarathi G (2003) Adverse drug reactions in a Southern Indian hospital—their severity and cost involvement. Pharmacol Drug Safe 12:687–692CrossRefGoogle Scholar
  16. 16.
    Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, Seger DL, Shu K, Federico F, Leape LL, Bates DW (2003) Adverse drug reactions in ambulatory care. N Engl J Med 348:1556–1564PubMedCrossRefGoogle Scholar
  17. 17.
    Nebeker JR, Barach P, Samore MH (2004) Clarifying adverse drug events: a clinicians guide to terminology, documentation, and reporting. Ann Intern Med 140:795–801PubMedGoogle Scholar
  18. 18.
    Nebeker JR, Hoffmann JM, Weir CR, Bennett CL, Hurdle JF (2005) High rates of adverse drug events in a highly computerized hospital. Arch Intern Med 165:1111–1116PubMedCrossRefGoogle Scholar
  19. 19.
    Lindquist M, Edwards IR (2001) The WHO programme for International Drug Monitoring, its database, and the technical support of the Upssala Monitoring Center. J Rheumatol 28:1180–1187PubMedGoogle Scholar
  20. 20.
    Santos WJQS, Zanetta DMT, Pires AC, Lobol SMA, Lima EQL, Burdmann EA (2006) Patients with ischaemic, mixed and nephrotoxic acute tubular necrosis in the intensive care unit— a homogeneous population? Crit Care 10:R68 ( 10.1186/cc4904)
  21. 21.
    Kapur N, Cooper J, King-Hele S, Webb R, Lawlor M, Rodway C, Appleby L (2006) The repetition of suicidal behaviour: a multicenter cohort study. J Clin Psychiatry 67:1599–1609PubMedCrossRefGoogle Scholar
  22. 22.
    Hallas J, Haghfelt T, Gram LF, Grodum E, Damsbo N (1990) Drug related admissions to a cardiology department; frequency and avoidability. J Intern Med 228:379–384PubMedCrossRefGoogle Scholar
  23. 23.
    Hallas J, Gram LF, Grodum E, Damsbo N, Brøsen K, Haghfelt T, Harvald B, Beck-Nielsen J, Worm J, Jensen KB (1992) Drug related admissions to medical wards: a population based survey. Br J Clin Pharmacol 33:61–68PubMedGoogle Scholar
  24. 24.
    Schneeweiss S, Hasford J, Gottler M, Hoffmann A, Riethling AK, Avorn J (2002) Admissions caused by adverse drug events to internal medicine and emergency departments in hospitals: a longitudinal population-based study. Eur J Clin Pharmacol 58:285–291PubMedCrossRefGoogle Scholar
  25. 25.
    Cullen DJ, Sweitzer BJ, Bates DW, Burdick EMS, Edmondson A, Leape LL (1997) Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care unit. Crit Care Med 25:1289–1297PubMedCrossRefGoogle Scholar
  26. 26.
    Kane-Gill SL, Devlin JW (2006) Adverse drug event reporting in intensive care units: a survey of current practices. Ann Pharmacother 40:1267–1273PubMedCrossRefGoogle Scholar
  27. 27.
    Hawton K, Fagg J, Simkin S, Bale E, Bond A (1997) Trends in deliberate self-harm in Oxford, 1985–1995. Br J Psychiatr 171:556–560CrossRefGoogle Scholar
  28. 28.
    Schaper A, Renneberg B, Desel H, Langer C (2006) Intoxication-related fatalities in northern Germany. Eur J Intern Med 17:474–478PubMedCrossRefGoogle Scholar
  29. 29.
    O’Loughlin S, Sherwood J (2005) A 20-year review of trends in deliberate self-harm in Kidderminster, 1981–2000. Soc Psychiatry Psychiatr Epidemiol 40:446–453PubMedCrossRefGoogle Scholar
  30. 30.
    Buckley NA, Whyte IM, Dawson AH, McManus PR, Ferguson NW (1995) Self-poisoning in Newcastle, 1987–1992. Med J Aust 162:190–193PubMedGoogle Scholar
  31. 31.
    Whyte IM, Dawson AH, Buckley NA, Carter GL, Levey CM (1997) A model for the management of self-poisoning. Med J Aust 167:142–146PubMedGoogle Scholar
  32. 32.
    Michel K (2000) Methods used for parasuicide: results of the WHO/EURO Multicentre Study on Parasuicide. Soc Psychiatry Psychiatr Epidemiol 35:156–163PubMedCrossRefGoogle Scholar
  33. 33.
    Carter GL, Clover K, Whyte IM, Dawson AH, D’Este C (2005) Postcards from the Edge project: randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning. BMJ.  10.1136/bmj.38579.455266.E0
  34. 34.
    Riedl MA, Casillas AM (2003) Adverse drug reactions: types and treatment options. Am Fam Physician 68:1781–1790PubMedGoogle Scholar
  35. 35.
    Johnstone DM, Kirking DM, Vinson BE (1995) Comparison of adverse drug reactions detected by pharmacy and medical records departments. Am J Health Syst Pharm 52:297–301PubMedGoogle Scholar
  36. 36.
    Kapur N, Cooper J, Hiroeh U, May C, Appleby L, House A (2004) Emergency department management and outcome for self-poisoning: a cohort study. Gen Hosp Psychiatry 26:36–41PubMedCrossRefGoogle Scholar
  37. 37.
    Kelly CB, Weir J, Rafferty T, Galloway R (2000) Deliberate self-poisoning presenting at a rural hospital in Northern Ireland 1976–1996: relationship to prescribing. Eur Psychiatry 15:348–353PubMedCrossRefGoogle Scholar
  38. 38.
    Owens D, Horrocks J, House A (2002) Fatal and non-fatal repetition of self-harm: systematic review. Br J Psychiatr 181:193–199CrossRefGoogle Scholar
  39. 39.
    Schneeweiss SG, Goettler M, Hasford J (1997) Adverse drug events in hospitalized patients. JAMA 277:1352–1353PubMedCrossRefGoogle Scholar
  40. 40.
    Arimone Y, Begaud B, Miremont-Salame G, Fourrier-Reglat A, Moore N, Molimard M, Haramburu F (2005) Agreement of expert judgment in causality assessment of adverse drug reactions. Eur J Clin Pharmacol 61:169–173PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Lukas Schwake
    • 1
  • Ines Wollenschläger
    • 1
  • Wolfgang Stremmel
    • 1
  • Jens Encke
    • 1
  1. 1.Department of Internal Medicine IV (Gastroenterology, Infectious Diseases, Intensive Care Medicine)Medical University Hospital HeidelbergHeidelbergGermany

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