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Thursday, June 29, 2017

Adverse Events Reported to Be Higher for Neurological In-Patients in Canadian Study

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BY KURT SAMSON

Nearly 50 percent of adverse events that occur in hospitals are preventable, experts in patient safety told Neurology Today, which is why new data from a Canadian study showing that patients with neurological conditions had significantly more complications that those in the general hospital population are disturbing. The report, they said, speaks to the need for evidence-based best practices that better promote hospital safety.

Published in the June 14 online edition of Neurology, the retrospective, population-based study looked at discharge data for 177,612 pediatric and adult patients with neurological conditions from 115 Alberta health care facilities from 2009 to 2015. The report found 11 adverse events (AEs) occurred for every 100 admissions for neurological conditions — this, compared with an earlier (2004) Canadian Adverse Events Study that found 7.5 AEs per 100 patients admitted for any condition at a representative sample of Canadian hospitals.

In the new study, AEs occurred most often in patients with spinal cord injury, stroke, Alzheimer disease and related dementia (ADRD), and traumatic brain injury (TBI). Infections and respiratory complications were the most common AEs except in brain tumor and spinal cord injury patients. Patients with spinal cord injury had 5.4 times greater odds of an AE compared to those with other neurological conditions. Adverse events were also more common in older patients and in those with higher comorbidity scores.

"Neurological patients with AEs had 2.4 times the odds of dying compared to those without AEs," said lead author Nathalie Jetté, MD, professor of neurology and community health sciences at the University of Calgary Cumming School of Medicine and Canada Research Chair in Neurological Health Services Research at the Hotchkiss Brain Institute & O'Brien Institute for Public Health.

"Our findings support previous reports that hospitalized patients are at great risk for AEs, with higher estimates reported in this neurological population compared to the prior Canadian study in the general hospital population." She noted that a number other international studies have reported that around 37 percent to 51 percent of AEs in hospital patients are preventable.

There are several of steps that can be taken to minimize the risk of AEs in neurological patients such as determining fall risk on admission, avoiding sedating medications, assessing swallowing function early, implementing deep venous thrombosis prophylaxis when necessary and doing careful medication reconciliation so patients do not miss any critical drugs on admission, noted Dr. Jetté.

"The time is right to carefully explore the reasons for these AEs and to develop and implement standardized clinical care pathways to reduce the rates of AEs for hospitalized neurological patients," she said.

The study authors assessed adverse events from discharge data for patients with one of nine neurological conditions: ADRD, brain tumor, epilepsy, motor neuron disease, multiple sclerosis, parkinsonism/Parkinson disease, spinal cord injury, traumatic brain injury, and stroke.

The researchers included 15 AEs in 18 categories: infections; ulcers; endocrinological AEs; venous thromboembolic; cardiac; respiratory; hemorrhagic; drug-related; fluid-related; obstetrical; fetal; surgical; traumatic; anesthetic; delirium-related; other CNS issues; gastrointestinal; and falls.

Among spinal cord patients, AEs occurred in 39.4 out of every 100 admissions, and among these patients, surgery-related AEs accounted for the highest proportion of AEs followed by infections and respiratory-related AEs (24.4 percent, 23.9 percent, and 16.7 percent, respectively).

The reason for the high proportion of AEs in those with a spinal cord injury is likely multifactorial, Dr. Jetté told Neurology Today. Spinal cord patients were more likely to have a surgical AE, she noted, adding that these patients have more procedures and interventions in the hospital.

Look for expanded coverage of this study in the July 6 issue of Neurology Today.