Detection of adverse drug reactions in a neurological department: comparison between intensified surveillance and a computer-assisted approach.
OBJECTIVE
Adverse drug reactions (ADRs) leading to hospitalisation or occurring during hospital stay contribute significantly to patient morbidity and mortality as well as representing an additional cost for healthcare systems. The aim of this study was to provide data about the type and incidence of ADRs in a neurological department and to compare two different methodological approaches to collecting information on ADRs.


METHODS
The two methods used were intensified surveillance of neurological wards by daily ward rounds and computer-assisted screening for ADRs by means of pathological laboratory parameters.


RESULTS
Of admissions to the neurological department, 2.7% were caused by an ADR and 18.7% of patients experienced at least one ADR during hospitalisation. The positive predictive values of pathological laboratory parameters ranged between 0% (eosinophil count) and 100% for increased drug serum concentrations and international normalised ratio, i.e. the latter were always accompanied by a clinically relevant ADR. However, only half of all ADR could be detected by pathological laboratory parameters, the sensitivity of this method came to 45.1% with a specificity of 78.9%.


CONCLUSIONS
Similar to departments of internal medicine, a high number of ADRs occur on neurological wards. The predominant ADRs were those typical of neurotropic medications such as dyskinesia and increased sedation. Due to the age of the patients involved, cardiovascular co-medication is often prescribed and represents an additional risk factor for ADRs. By measuring pathological laboratory parameters the majority of ADRs could not be detected in neurological patients.
Thuermann
Petra A
PA
Philipp Klee-Institute of Clinical Pharmacology, Hospital Wuppertal GmbH, University of Witten/Herdecke, Wuppertal, Germany. Petra.Thuermann@klinikum-wuppertal.de
Windecker
Roland
R
Steffen
Joachim
J
Schaefer
Markus
M
Tenter
Ute
U
Reese
Erich
E
Menger
Hermann
H
Schmitt
Klaus
K
D016907:Adverse Drug Reaction Reporting Systems; D002493:Central Nervous System Diseases; D004347:Drug Interactions; D016903:Drug Monitoring; D006748:Hospital Departments; D006801:Humans; D008491:Medical Informatics Applications; D009462:Neurology; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity