The diseases we cause: Iatrogenic illness in a department of internal medicine

Abstract

Background: The aim of this study was to estimate the incidence, main causes, and risk factors of iatrogenic disease occurring in a department of internal medicine. Methods: Over a 1-year period, physicians systematically filled out a 2-page questionnaire for all patients admitted to the ward. A database was created and the data were statistically analyzed. Patients undergoing immunosuppressive, chemo-, or radiation therapy were excluded. Missing data were completed by reviewing the patients' charts. The patients were then divided into two groups: those with and those without iatrogenic disease. The groups were compared using several parameters including gender, age, social features, days of hospitalization, associated illness, functional status, medical impression, prognosis, associated renal or liver function impairment, drugs taken daily, and outcome. In the group with iatrogenic disease, the type, severity, and predictability were also analyzed. Results: Of the 879 patients admitted to the ward, 445 completed questionnaires and were included in the study. A total of 102 patients (22.9%) developed 121 iatrogenic events. Forty-four patients (43.1%) were admitted for iatrogenic illness, 10 (9.8%) developed lifethreatening events, and in 3 (6.8%) it was the cause of death. Fifty-eight patients (56.8%) registered 77 episodes of iatrogenic disease during their hospital stay, 20 (19.6%) developed life-threatening events, and 9 (11.7%) died, 4 (5.2%) of an iatrogenic cause (nosocomial infections). Significant differences were found in 20 out of 26 parameters studied ( p b 0.005 for all cases; 95% confidence interval). Eighteen percent of all iatrogenic disease was severe, 61.9% predictable, 54.5% avoidable, and 59% drug-related, 80% of which was due to side effects or adverse reactions. Infection and metabolic and electrolyte disorders were the most frequent effects. Conclusions: It is possible to identify risk factors for iatrogenic events. Chronically ill elderly inpatients are the main target of iatrogenic events.

Medical adverse events in elderly hospitalized patients: A prospective study

“…Hospitalized patients aged 65 years and older are at a higher risk of AEs than young adults (1),(2),(5)-(8),(10)-(15). The incidence of AEs ranges from 5% to 58% in the elderly group (1),(2),(4),(5),(11),(12),(16)-(19).…”

Which Adverse Events Are Related to Health Care during Hospitalization in Elderly Inpatients?

“…In the literature, factors associated with the occurrence of adverse events were female sex 22,23, number of drugs 5,6,24,25, comorbidities, dependency 5,6,24, lower weight, and smoking history with concurrent diseases 4. In our study, lack of power and overmatching cannot be excluded.…”

Towards a Better Understanding of Health and Disease

“…Since the course of drug action becomes smaller over a period of time, the dosage often needs to be increased or the drug changed when it is found to be no longer effective in ameliorating the symptom conditions of the disease; c. Many drugs are known to have side-effects where additional symptoms or sensations of a newer type of discomfort arise in the body-mind continuum. Approximately 6.5% of all hospitalization in general population is as a result of adverse drug events [37] causing ~225,000 deaths annually in US alone [38]; d. Often the individual's well-being declines over time due to strengthening of the primary disease with conventional medication.…”