Choi Byungho, Kim Sun Hyu, Lee Hyeji
Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Allergy Asthma Immunol Res. 2018 Mar;10(2):137-143. doi: 10.4168/aair.2018.10.2.137.
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.
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.
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.
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.
针对过敏反应已有大量研究，但许多研究对象仅限于登记有过敏反应编码的患者。然而，过敏反应编码的使用往往不足。本研究旨在调查过敏反应编码登记的准确性以及过敏患者中准确和不准确的过敏反应登记的临床特征。
这项回顾性研究评估了2012年至2016年间就诊于大学医院急诊科的成年患者的病历。研究对象分别被分为在过敏反应以及其他过敏相关编码和症状相关编码下登记有准确和不准确过敏反应编码的组。
在211486名患者中，618人（0.29%）发生了过敏反应。其中，161人和457人分别被归入准确编码组和不准确编码组。两组在平均年龄、前往急诊科的交通方式、既往过敏反应史、癌症史以及过敏反应原因方面存在差异。皮肤症状在不准确编码组中更频繁出现，而心血管和神经症状在准确编码组中更常见。严重症状和意识不清在准确编码组中更常见。准确编码组中，氧气供应、插管和肾上腺素作为过敏反应治疗手段的使用更为普遍。出现心血管症状、严重症状且使用肾上腺素的过敏患者更有可能被准确登记为患有过敏反应疾病编码。
在过敏反应病例中，更多患者在其他过敏相关编码和症状相关编码下登记不准确，而非在过敏反应疾病编码下准确登记。心血管症状、严重症状和肾上腺素治疗是过敏患者准确登记为过敏反应疾病编码的相关因素。
