Epidemiology and nature of adverse events in the ICU

Introduction

Critically ill patients require high-intensity care may be at especially high risk of iatrogenic injury because they are severely ill [1]. We sought to study the incidence and nature of adverse events in the critical care setting.

Methods

We conducted a prospective 6-month observational study in a medicosurgical ICU. We included patients whose length of stay was >24 hours. Reporters were asked to provide the identification of the adverse events, date and time, and details with regard to the risk factors. The morbi-mortality was also recorded.

Results

A total of 250 patients were admitted to the ICU during an observation period, 102 were included. The incidence of adverse events was 59.8%. We found 222 adverse events (2.2 adverse events per patient). The most common adverse events as categorized by organ systems were metabolic (52%), cardiovascular, respiratory and finally infectious. Among all adverse events, only hyperglycaemia and hypoglycaemia were considered to be iatrogenic adverse events. No association was observed between adverse events and mortality.

Conclusion

We found that the incidence of adverse events was 59.8%. Some prior critical care safety studies have identified fewer adverse events than this one (3 to 37%) [2]. This difference may have occurred because methods are not standardized; important differences refer to the definitions of the concept of iatrogenic, modes of assessment (prospective, retrospective or transversal), population size, and the observation period. The high incidence of adverse events in our study is due to the exhaustive assessment of adverse events.