A systematic review of adult admissions to ICUs related to adverse drug events

Abstract

Adverse drug events (ADE) may lead to hospital admission, and in some cases admission to an ICU is mandatory. We conducted a systematic review dealing with the incidence of ADE requiring ICU admission in adult patients, the reference population being all ICU admissions. Medline, Embase and Web of Science databases were screened from January 1982 to July 2014, using appropriate key words. Only original articles in English reporting the incidence of ADE requiring ICU admission in adult patients among total ICU admissions were included. Article eligibility was assessed by two independent reviewers, a third being involved in cases of disagreement. All reported characteristics (type of ICU, characteristics of patients, incidence of ADE, severity and preventability, drugs involved, causality) in the selected articles were collected for the review. The quality of studies was independently assessed by two reviewers with a specific score that we developed. A meta-analysis was conducted. Inclusion criteria were fulfilled by 11 studies out of the 4,311 identified in the initial literature search. The median (interquartile) quality score was 0.61 (0.44; 0.69). The reported incidences of ADE requiring ICU admission in adult patients ranged from 0.37 to 27.4%, with an associated mortality rate ranging from 2 to 28.1% and a mean length of stay ranging from 2.3 to 6.4 days. Preventable events accounted for 17.5 to 85.7% of the events. Costs and mechanisms at the root of ADE were investigated in only two and five studies, respectively. The forest plot examining the incidence of ADE requiring ICU admission in adult patients was associated with high heterogeneity (I2 statistic >98%), and the shape of the corresponding funnel plot was asymmetric. Heterogeneity across studies concerned many features, including studied populations, events considered, causality assessment methods, definitions of preventability and severity. Despite the heterogeneity of the reports, our review indicates that ICU admission due to ADE is a significant issue that should deserve further interest. The review led us to propose a list of items devoted to the reporting of future studies on ADE requiring ICU admissions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0643-5) contains supplementary material, which is available to authorized users.

PRISMA harms checklist: improving harms reporting in systematic reviews

“…1 Figure 3 presents an example for item 19 (risk of bias within studies). 71 Recommendations for reporting harms in systematic reviews Review authors should consider the possible sources of bias that could affect the specific harm under consideration within the review. The study designs may be considered ideal for efficacy measurement (for example, in terms of standard indicators for risk of bias such as concealment of allocation, sequence generation, and double blinding).…”

An observational study of adult admissions to a medical ICU due to adverse drug events

“…For causality assessment, 3 different scales were used [ 27 – 29 ]. As previously reported by Kane-Gill et al [ 32 ] and Jolivot et al [ 19 ], Karch and Lasagna and Naranjo scales are not tailored for ICU as ADE should be excluded if patient’s condition did not improve after drug dechallenge. Due to the severity of most of the cases, this condition cannot be fulfilled in ICU.…”

“…However, data related to ADE as a cause of ICU admission are scarce and heterogeneous. Based on 12 studies published between 1986 and 2014 [ 7 – 18 ], a recent systematic review reported incidences of ICU admissions due to an ADE ranging from 0.37 to 27.4 % and mortality rates ranging from 2 to 28.1 % [ 7 – 19 ]. Preventable ADEs accounted for 17.5 to 85.7 % of the ICU admissions.…”

Role of Medicines of Unknown Identity in Adverse Drug Reaction-Related Hospitalizations in Developing Countries: Evidence from a Cross-Sectional Study in a Teaching Hospital in the Lao People’s Democratic Republic

“…This tool relied on the visual comparison of the features of the tablet/capsule with those of 494 known unambiguously labelled medicines collected from private community pharmacies in Vientiane Capital. One sample of all solid oral dosage forms (tablets and capsules) of medicines belonging to the following classes, chosen as most commonly involved in ADRs [ 25 , 26 , 32 ], was bought to create the collection: antidiabetic, anti-infective, cardiovascular, antithrombotic, analgesic, anti-inflammatory medicines and medicines for central nervous system disorders. Identifications were performed using photographs of the reference pharmaceutical units by three health workers—two pharmacists (NS and NM) and one medical doctor (CS)—without conferring.…”