Drug-related deaths in a department of internal medicine

Background: Drug therapy is associated with adverse effects, and fatal adve rse drug events (ADEs) have become major hospital problems. Our study asses ses the incidence of fatal ADEs in a major medical department and identifie s possible patient characteristics signifying fatal ADE risk. Methods: During a 2-year period, a multidisciplinary study group examined a ll 732 patients who died-5.2% of the 13992 patients admitted to the Departm ent of Internal Medicine, Central Hospital of Akershus, Nordbyhagen, Norway . Decisions about the presence or absence of fatal ADEs were based on aggre gated clinical records, autopsy results, and findings from premortem and po stmortem 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 in directly (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) we re older, had more diseases, and used more drugs than those without fatal A DEs (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 s uspicion of a fatal ADE. Major culprit drugs were cardiovascular, antithrom botic, and sympathomimetic agents. Conclusions: Fatal ADEs represent a major hospital problem, especially in e lderly patients with multiple diseases. A higher number of drugs administer ed 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 premortern and postmortem drug analyse s were important for recognizing and excluding suspected fatal ADEs.