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Drug-Related Deaths in a Department of Internal Medicine
Just Ebbesen, MD;
Ingebjørg Buajordet, MSc;
Jan Erikssen, MD, PhD;
Odd Brørs, MD, PhD;
Thor Hilberg, MD, PhD;
Helge Svaar, MD;
Leiv Sandvik, MSc, PhD
Arch Intern Med. 2001;161:2317-2323.
Background Drug therapy is associated with adverse effects, and fatal adverse drug
events (ADEs) have become major hospital problems. Our study assesses the
incidence of fatal ADEs in a major medical department and identifies possible
patient characteristics signifying fatal ADE risk.
Methods During a 2-year period, a multidisciplinary study group examined all
732 patients who died—5.2% of the 13 992 patients admitted to the
Department of Internal Medicine, Central Hospital of Akershus, Nordbyhagen,
Norway. Decisions about the presence or absence of fatal ADEs were based on
aggregated clinical records, autopsy results, and findings from premortem
and postmortem drug analyses.
Results In 18.2% of the patients (133/732) (95% confidence interval, 15.4%-21.0%),
deaths were classified as being directly (64 [48.1%] of 133) or indirectly
(69 [51.9%] of 133) associated with 1 or more drugs (this equals 9.5 deaths
per 1000 hospitalized patients). Those with fatal ADEs (cases) were older,
had more diseases, and used more drugs than those without fatal ADEs (noncases).
In 75 of the 133 patients with fatal ADEs, autopsy findings and/or drug analysis
data were decisive for recognizing the ADEs; in 62 of the remaining 595 patients,
similar data proved necessary to exclude the suspicion of a fatal ADE. Major
culprit drugs were cardiovascular, antithrombotic, and sympathomimetic agents.
Conclusions Fatal ADEs represent a major hospital problem, especially in elderly
patients with multiple diseases. A higher number of drugs administered was
associated with a higher frequency of fatal ADEs, but whether a high number
of drugs is an independent risk factor for fatal ADEs is unsettled. Autopsy
results and the findings of premortem and postmortem drug analyses were important
for recognizing and excluding suspected fatal ADEs.
From the Foundation for Health Services Research (Drs Ebbesen and Sandvik)
and the Departments of Internal Medicine (Dr Erikssen) and Pathology (Dr Svaar),
Central Hospital of Akershus, Nordbyhagen, Norway; and the Norwegian Medicines
Control Authority (Ms Buajordet), the Division of Clinical Pharmacology and
Toxicology, Clinical Chemistry Department, Ullevaal University Hospital (Dr
Brørs), and the National Institute of Forensic Toxicology (Dr Hilberg),
Oslo, Norway.
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