Are Registration of Disease Codes for Adult Anaphylaxis Accurate in the Emergency Department?

다국어 초록 (Multilingual Abstract)

Purpose: There has been active research on anaphylaxis, but many study subjects are limited to patients registered with anaphylaxis codes. However, anaphylaxis codes tend to be underused. The aim of this study was to investigate the accuracy of anaphylaxis code registration and the clinical characteristics of accurate and inaccurate anaphylaxis registration in anaphylactic patients. Methods: This retrospective study evaluated the medical records of adult patients who visited the university hospital emergency department between 2012 and 2016. The study subjects were divided into the groups with accurate and inaccurate anaphylaxis codes registered under anaphylaxis and other allergy-related codes and symptom-related codes, respectively. Results: Among 211,486 patients, 618 (0.29%) had anaphylaxis. Of these, 161 and 457 were assigned to the accurate and inaccurate coding groups, respectively. The average age, transportation to the emergency department, past anaphylaxis history, cancer history, and the cause of anaphylaxis differed between the 2 groups. Cutaneous symptom manifested more frequently in the inaccurate coding group, while cardiovascular and neurologic symptoms were more frequently observed in the accurate group. Severe symptoms and non-alert consciousness were more common in the accurate group. Oxygen supply, intubation, and epinephrine were more commonly used as treatments for anaphylaxis in the accurate group. Anaphylactic patients with cardiovascular symptoms, severe symptoms, and epinephrine use were more likely to be accurately registered with anaphylaxis disease codes. Conclusions: In case of anaphylaxis, more patients were registered inaccurately under other allergy-related codes and symptom-related codes rather than accurately under anaphylaxis disease codes. Cardiovascular symptoms, severe symptoms, and epinephrine treatment were factors associated with accurate registration with anaphylaxis disease codes in patients with anaphylaxis.

참고문헌 (Reference)

1 노의정, "국내 중부지역 아나필락시스 환자의 임상적 특성 연구" 대한 소아알레르기 호흡기학회 18 (18): 61-69, 2008

2 Simons FE, "World allergy organization guidelines for the assessment and management of anaphylaxis" 4 : 13-37, 2011

3 Decker WW, "The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project" 122 : 1161-1165, 2008

4 Panesar SS, "The epidemiology of anaphylaxis in Europe: a systematic review" 68 : 1353-1361, 2013

5 Lieberman P, "The diagnosis and management of anaphylaxis practice parameter: 2010 update" 126 : 477-480, 2010

6 Sampson HA, "Symposium on the definition and management of anaphylaxis: summary report" 115 : 584-591, 2005

7 Sampson HA, "Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium" 117 : 391-397, 2006

8 Johansson SG, "Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003" 113 : 832-836, 2004

9 예영민, "Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study" 대한천식알레르기학회 7 (7): 22-29, 2015

10 Rudders SA, "Multicenter study of repeat epinephrine treatments for food-related anaphylaxis" 125 : e711-e718, 2010

11 Brockow K, "Management of hypersensitivity reactions to iodinated contrast media" 60 : 150-158, 2005

12 Tham EH, "Epinephrine auto-injector prescriptions as a reflection of the pattern of anaphylaxis in an Asian population" 29 : 211-215, 2008

13 Lieberman P, "Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group" 97 : 596-602, 2006

14 Yocum MW, "Epidemiology of anaphylaxis in Olmsted County: a population-based study" 104 : 452-456, 1999

15 Yang MS, "Epidemiologic and clinical features of anaphylaxis in Korea" 100 : 31-36, 2008

16 Gold MS, "EpiPen epidemic or good clinical practice?" 39 : 376-377, 2003

17 Brown SG, "Clinical features and severity grading of anaphylaxis" 114 : 371-376, 2004

18 Nannan Jiang, "Characteristics of Anaphylaxis in 907 Chinese Patients Referred to a Tertiary Allergy Center: A Retrospective Study of 1,952 Episodes" 대한천식알레르기학회 8 (8): 353-361, 2016

19 Ben-Shoshan M, "Anaphylaxis: past, present and future" 66 : 1-14, 2011

20 Brown SG, "Anaphylaxis: diagnosis and management" 185 : 283-289, 2006

21 Wood RA, "Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States" 133 : 461-467, 2014

22 Simons FE, "Anaphylaxis epidemic: fact or fiction?" 122 : 1166-1168, 2008

23 Simons FE, "Anaphylaxis" 125 : S161-S181, 2010

24 이소연, "A Multicenter Retrospective Case Study of Anaphylaxis Triggers by Age in Korean Children" 대한천식알레르기학회 8 (8): 535-540, 2016