Drug-related deaths in a university central hospital.
OBJECTIVE
The objectives were to determine the incidence of drug-related deaths in a university hospital and to find out which drugs are most commonly involved in these cases.


METHODS
The files of 1511 death cases (97.7% of all death cases in the Helsinki University Central Hospital during the year 2000) were scrutinised. In the cases of suspected drug-related deaths excluding suicides, the medication, its duration and indications, the route of drug administration, and the type of the adverse reactions were determined. The probability of a fatal adverse drug reaction was classified according to WHO's classification. In addition, the incidence of drug-related deaths was calculated from the death certificates.


RESULTS
Scrutiny of the patients' files showed that 75 of the death cases (5.0% of all deaths) were certainly or probably drug-related. This corresponds to about 0.05% of all hospital admissions. The most common adverse reactions were neutropenia caused by antineoplastic agents and gastrointestinal or intracranial haemorrhage due to anticoagulants or nonsteroidal anti-inflammatory drugs (NSAIDs). The incidence of drug-related deaths is only 0.5% when based on the International Classification of Diseases (ICD) codes in death certificates.


CONCLUSIONS
Adverse drug reaction is a significant cause of death. Most of the deaths occurred in seriously ill patients with high-risk medication and they are seldom preventable. Incidence figures based on death certificates only may seriously underestimate the true incidence of fatal adverse reactions.
Juntti-Patinen
L
L
Department of Clinical Pharmacology, Helsinki University Central Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland.
Neuvonen
P J
PJ
D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005387:Finland / Q000453:epidemiology; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D004364:Pharmaceutical Preparations / Q000145:classification
D004364:Pharmaceutical Preparations