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Open Access Highly Accessed Research article

International prevalence of adverse drug events in hospitals: an analysis of routine data from England, Germany, and the USA

Jürgen Stausberg

Author Affiliations

Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 München, Germany

BMC Health Services Research 2014, 14:125  doi:10.1186/1472-6963-14-125

Published: 13 March 2014

Abstract

Background

Adverse drug events (ADEs) are frequent in hospitals, occurring either in patients before admission or as a nosocomial event, and either as a drug reaction or as a consequence of a medication error. Routine data primarily recorded for reimbursement purposes are increasingly being used on a national level both in pharmacoepidemiological studies and in trigger tools. The aim of this study was to compare the prevalence rates of coded ADEs in hospitals on a transnational level.

Methods

Hospital data for England and the USA were obtained for the fiscal or calendar year 2006. German data for 2006 were accessed via teleprocessing with the Federal Statistical Office. The datasets from England and the USA were adapted to the German data. About 6 million (England), 7 million (USA), and 16 million (Germany) inpatients could be included. ADEs were identified through a list of codes used in the national diagnosis classifications.

Results

The overall prevalence rate (and 95% confidence interval, CI) of coded ADEs was 3.22% (3.20–3.23%) for England, 4.78% (4.73–4.83%) for Germany, and 5.64% (5.63–5.66%) for the USA. Most of the English ADE cases occurred in patients admitted as emergency. A non-surgical status and a longer length of stay were consistently associated with the occurrence of an ADE. Enterocolitis caused by Clostridium difficile was the most frequent ADE in all countries.

Conclusions

According to routine data, the overall ADE prevalence rates for England, Germany, and the USA are different. However, the differences are narrower than those determined from the rates of ADEs or adverse drug reactions inferred from prospective or retrospective pharmacoepidemiological studies. Since the ADEs in the countries examined in this study share several characteristics, the use of routine data for transnational research on ADEs is feasible.

Keywords:
Adverse drug event; Adverse drug reaction reporting system; Hospitals; International classification of diseases; Medication errors; Routine data