La pathologie médicamenteuse comme cause d’hospitalisation est un problème majeur de santé publique. Une étude de l’Association pédagogique nationale pour l’enseignement de la thérapeutique (APNET) a consisté à recueillir toutes les observations d’effets indésirables médicamenteux (EIM) pendant deux semaines dans sept services d’accueil et d’urgences (SAU) de sept centres hospitaliers français en 2003. Parmi 1663 patients, 263 patients venaient consulter pour un EIM probable (I2), vraisemblable (I3) ou très vraisemblable (I4). Les malades avec EIM étaient globalement plus âgés que ceux sans EIM (62,4 versus 53,8 ans ; p=0,0016) ; en outre, ils avaient un score de gravité plus élevé (p=0,0003). La fréquence des EIM est apparue très directement liée au nombre de médicaments reçus. Les symptômes des EIM, très variés, appartenaient à tous les champs de la sémiologie. Les médicaments les plus fréquemment incriminés étaient les psychotropes, les diurétiques, les anticoagulants, les médicaments cardiovasculaires, les antalgiques et les anti-inflammatoires non stéroïdiens (AINS). Dans 123 cas sur 263 (46,8 %), l’EIM fut considéré comme « évitable » en raison d’un mésusage du médicament par les médecins et/ou par les malades.

Adverse-drug events (ADEs) are a substantial cause of hospital admissions. However, little is known about the incidence, preventability and severity of ADEs resulting in emergency-department visits. To address this issue, we conducted a prospective survey in emergency departments of French public hospitals.

This study was performed over two periods of one week in 2003 in seven French-emergency departments. All patients aged 15 and over presenting with medical complaints were included in the study, except those with alcohol intoxication or intentional-drug poisoning. Each patient was assessed by two local emergency physicians to determine whether the visit was the result of an ADE. All medical records were subsequently validated by an independent group of medical lecturers in iatrogenic disorders.

Out of a total of 1663 patients consulting, 263 of these patients consulted an emergency physician because of an ADE. Patients with ADEs were older than those without (62.4 versus 53.8 years; p=0.0016). Furthermore, ADE patients were more likely to have a higher severity presentation than the non-ADE group (p=0.0003). The number of drug exposures was significantly higher in patients with ADE. The most frequently incriminated drug classes were psychotropic agents, diuretics, anticoagulants and other cardiovascular drugs, and analgesics, including non-steroidal anti-inflammatory agents. In 123 cases (46.6%), the ADE was judged to be preventable.

ADEs leading to an emergency-department visits are frequent and many are preventable, confirming that there is a need to develop prevention strategies.