Recognizing, Reporting, and Reducing Adverse Drug Reactions

South Med J. 2001;94(4) 

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Lazarou et al[12] studied ADRs that occurred in hospitals and those that led to hospital admission. The study was a meta-analysis using 39 prospective studies from US hospitals. Excluded were errors in drug administration, noncompliance, overdose, abuse, and possible ADRs. It was estimated that in 1994, 702,000 hospitalized patients had an ADR and that 1,547,000 patients were hospitalized because of an ADR. The total number of deaths occurring as a result of ADRs was estimated to be 106,000 (confidence interval, 76,000 to 137,000), making ADRs the fourth to sixth leading cause of death. Of little surprise was the fact that the elderly had the highest incidence of ADRs. In an editorial in the same issue of JAMA, Bates[13] warned that the incidence rate of ADRs reported by Lazarou et al[12] may have been inflated. Bates indicated that the hospitals used in the meta-analysis were tertiary care centers with sicker patients who were more likely to have ADRs. He conceded that the incidence of ADRs is much higher than generally accepted. The reason for this, he argued, is that hospitals rely on spontaneous reporting of ADRs, which identifies only 1 in 20 adverse reactions.


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