Drug Safety

, Volume 29, Issue 2, pp 161–168 | Cite as

Adverse Drug Reaction-Related Hospitalisations

A Nationwide Study in The Netherlands
  • Cornelis S. van der Hooft
  • Miriam C.J.M. Sturkenboom
  • Kees van Grootheest
  • Herre J. Kingma
  • Bruno H.Ch. StrickerEmail author
Original Research Article


Background: The incidence of adverse drug reaction (ADR)-related hospitalisations has usually been assessed within hospitals. Because of the variability in results and methodology, it is difficult to extrapolate these results to a national level.

Objectives: To evaluate the incidence and characteristics of ADR-related hospitalisations in The Netherlands in 2001.

Methods: We conducted a nationwide study of all hospital admissions in 2001. Data were retrieved from a nationwide computer database for hospital discharge records. All acute, non-planned admissions to all Dutch academic and general hospitals in 2001 were included in the study (n = 668 714). From these admissions we selected all hospitalisations that were coded as drug-related, but intended forms of overdose, errors in administration and therapeutic failures were excluded. Hence, we extracted all ADR-related hospitalisations. We compared age, sex and the risk of a fatal outcome between patients admitted with ADRs and patients admitted for other reasons, as well as the most frequent main diagnoses in ADR-related hospitalisations and which drugs most frequently caused the ADRs. In addition, we evaluated to what extent these ADRs were reported to the Netherlands Pharmacovigilance Centre Lareb for spontaneous ADR reporting.

Results: In 2001, 12 249 hospitalisations were coded as ADR related. This was 1.83% of all acute hospital admissions in The Netherlands (95% CI 1.80, 1.86). The proportion increased with age from 0.8% (95% CI 0.75, 0.85) in the <18 years group to 3.2% in the ≥80 years group (95% CI 3.08, 3.32). The most frequent ADR-related diagnoses of hospitalisations were bleeding (n = 1048), non-specified ‘unintended effect of drug’ (n = 438), hypoglycaemia (n = 375) and fever (n = 347). The drugs most commonly associated with ADR-related hospitalisations were anticoagulants (n = 2185), cytostatics and immunosuppressives (n = 1809) and diuretics (n = 979). Six percent of the ADR-related hospitalisations had a fatal outcome (n = 734). Older age and female gender were associated with ADR-related hospitalisations. Only approximately 1% of the coded ADRs causing hospitalisation were reported to our national centre for spontaneous ADR reporting.

Conclusion: The proportion of ADR-related hospitalisations is substantial, especially considering the fact that not all ADRs may be recognised or mentioned in discharge letters. Under-reporting of ADRs that result in hospital admission to our national centre for spontaneous ADR reporting was considerable.


Adverse Drug Reaction Secondary Diagnosis Main Diagnosis Adverse Drug Reaction Reporting Spontaneous Reporting System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



None of the authors have a conflict of interest and this research was not supported by external funds.


  1. 1.
    Roughead EE, Gilbert AL, Primrose JG, et al. Drug-related hospital admissions: a review of Australian studies published 1988-1996. Med J Aust 1998; 168(8): 405–8PubMedGoogle Scholar
  2. 2.
    Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998; 279(15): 1200–5PubMedCrossRefGoogle Scholar
  3. 3.
    Muehlberger N, Schneeweiss S, Hasford J. Adverse drug reaction monitoring-cost and benefit considerations. Part I: frequency of adverse drug reactions causing hospital admissions. Pharmacoepidemiol Drug Saf 1997; 6(S3): S71–7PubMedCrossRefGoogle Scholar
  4. 4.
    Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci 2002; 24(2): 46–54PubMedCrossRefGoogle Scholar
  5. 5.
    Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329(7456): 15–9PubMedCrossRefGoogle Scholar
  6. 6.
    Onder G, Pedone C, Landi F, et al. Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc 2002; 50(12): 1962–8PubMedCrossRefGoogle Scholar
  7. 7.
    Routledge PA, O’Mahony MS, Woodhouse KW. Adverse drug reactions in elderly patients. Br J Clin Pharmacol 2004; 57(2): 121–6PubMedCrossRefGoogle Scholar
  8. 8.
    Pouyanne P, Haramburu F, Imbs JL, et al. Admissions to hospital caused by adverse drug reactions: cross sectional incidence study. French Pharmacovigilance Centres. BMJ 2000; 320(7241): 1036PubMedCrossRefGoogle Scholar
  9. 9.
    International Classification of Diseases. 9th Rev. Clinical modification (ICD-9-CM). Michigan: Commission on Professional and Hospital activities, 1978Google Scholar
  10. 10.
    van Grootheest AC. Improving pharmacovigilance and the role of the pharmacist. [PhD dissertation]. Groningen: University of Groningen, 2003Google Scholar
  11. 11.
    Alvarez-Requejo A, Carvajal A, Begaud B, et al. Under-reporting of adverse drug reactions: estimate based on a spontaneous reporting scheme and a sentinel system. Eur J Clin Pharmacol 1998; 54(6): 483–8PubMedCrossRefGoogle Scholar
  12. 12.
    Eland IA, Belton KJ, van Grootheest AC, et al. Attitudinal survey of voluntary reporting of adverse drug reactions. Br J Clin Pharmacol 1999; 48(4): 623–7PubMedCrossRefGoogle Scholar
  13. 13.
    Nelson KM, Talbert RL. Drug-related hospital admissions. Pharmacotherapy 1996; 16(4): 701–7PubMedGoogle Scholar
  14. 14.
    Mannesse CK, Derkx FH, de Ridder MA, et al. Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 2000; 29(1): 35–9PubMedCrossRefGoogle Scholar
  15. 15.
    Mjorndal T, Boman MD, Hagg S, et al. Adverse drug reactions as a cause for admissions to a department of internal medicine. Pharmacoepidemiol Drug Saf 2002; 11(1): 65–72PubMedCrossRefGoogle Scholar
  16. 16.
    Hallas J, Haghfelt T, Gram LF, et al. Drug related admissions to a cardiology department; frequency and avoidability. J Intern Med 1990; 228(4): 379–84PubMedCrossRefGoogle Scholar
  17. 17.
    Williamson J, Chopin JM. Adverse reactions to prescribed drugs in the elderly: a multicentre investigation. Age Ageing 1980; 9(2): 73–80PubMedCrossRefGoogle Scholar
  18. 18.
    Davidsen F, Haghfelt T, Gram LF, et al. Adverse drug reactions and drug non-compliance as primary causes of admission to a cardiology department. Eur J Clin Pharmacol 1988; 34(1): 83–6PubMedCrossRefGoogle Scholar
  19. 19.
    Carbonin P, Pahor M, Bernabei R, et al. Is age an independent risk factor of adverse drug reactions in hospitalized medical patients? J Am Geriatr Soc 1991; 39(11): 1093–9PubMedGoogle Scholar
  20. 20.
    Lassila HC, Stoehr GP, Ganguli M, et al. Use of prescription medications in an elderly rural population: the MoVIES Project. Ann Pharmacother 1996; 30(6): 589–95PubMedGoogle Scholar
  21. 21.
    Straand J, Rokstad KS. Elderly patients in general practice: diagnoses, drugs and inappropriate prescriptions. A report from the More & Romsdal Prescription Study. Fam Pract 1999; 16(4): 380–8PubMedCrossRefGoogle Scholar
  22. 22.
    Roughead EE, Gilbert AL, Primrose JG, et al. Coding drug-related hospital admissions in the medical record: is it adequate for monitoring the quality of medication use? Aust J Hosp Pharm 1998; 28: 7–12Google Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  • Cornelis S. van der Hooft
    • 1
    • 2
  • Miriam C.J.M. Sturkenboom
    • 1
    • 3
  • Kees van Grootheest
    • 4
  • Herre J. Kingma
    • 2
  • Bruno H.Ch. Stricker
    • 1
    • 2
    Email author
  1. 1.Pharmaco-epidemiology Unit, Department of Epidemiology & BiostatisticsErasmus University Medical CentreRotterdamThe Netherlands
  2. 2.Inspectorate for Health CareThe HagueThe Netherlands
  3. 3.Department of Medical InformaticsErasmus University Medical CentreRotterdamThe Netherlands
  4. 4.Netherlands Pharmacovigilance Centre LarebThe Netherlands

Personalised recommendations