Abstract
Introduction: Because of the limitations of the spontaneous reporting system, the French hospital discharge database (PMSI) is a complementary tool for tracking adverse drug reactions (ADRs). Hence, regional phar- macovigilance centres search for ADR in the PMSI database using query systems based on a selection of ICD-10 codes. However, the performance of ICD-10 codes, i.e., the proportion of cases retained in relation to the number of cases identified rarely exceeds 40% [1]. In addition, some codes are associated with a high false positive rate and this method finally encourages the detection of ADRs that are already known. The objective of our study was to improve this detection method using a complementary text query in hospitalization reports.Material and methods: We evaluated a query based on two detection methods: one using 337 ICD-10 codes corresponding to potential ADRs searched in the PMSI database and the other, 37 ADR-related keywords searched in the conclusion section of hospitalization report letters. The query was retrospective, monthly, and concerned all patient stays after hospital discharge.Results: Between January and June 2022, the query identified 2092 stays potentially marked by an ADR. For this study, we examined 527 records. Following pharmacovigilance evaluation, 208 ADR were retained, which corresponds to a performance of 39.5%. The query by ICD-10 code only offers a higher performance of 38.1% compared to that obtained with the keywords query only (28.0%). However, the combination of the two methods allows a considerable improvement of the detection efficiency up to 63.9%. The keywords query also detected a serious case considered unexpected (MERS related to antiepileptic treatment) and a medication error.Discussion/Conclusion: The search process in the hospitalization report letters combined with a classic query in the PMSI gives encouraging first results and seems to be a promising way to improve the detection of adverse events, especially unexpected ones.Reference: [1] Osmont MN et al. “Utilisation du PMSI pour la détection d’effets indésirables médicamenteux” [Use of the PMSI for the detection of adverse drug reactions]. Therapie vol. 68,4 (2013): 285–95.