Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
J Allergy Clin Immunol Pract. 2019 Jan;7(1):259-264.e1. doi: 10.1016/j.jaip.2018.07.022. Epub 2018 Jul 31.
The study of allergic drug reactions has been limited because of challenges in identifying and confirming cases.
To determine the utility of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for identifying inpatient allergic drug reactions and to compare findings with previous data in the emergency department.
By reviewing medical records of inpatients with ICD-9-CM codes and E codes suggestive of allergic drug reactions at a large urban academic medical center, we determined codes that yielded the most drug allergy cases and identified culprit drugs.
In 2005 and 2010, 3337 and 5282 possible allergic drug reactions during hospitalization were identified and 1367 were reviewed. Allergic drug reactions were found in 409 (30.1%) of the reviewed charts, with 172 (29.7%) in 2005 and 237 (30.5%) in 2010. The codes that identified the highest percentage of true allergic drug reactions were dermatitis due to drug (693.0), allergic urticaria (708), angioneurotic edema (995.1), and anaphylaxis (995.0). Antibiotics were the most common cause (44.4%); however, multiple drug classes were often identified as likely culprit drugs.
Specific ICD-9-CM codes can identify patients with allergic drug reactions, with antibiotics accounting for almost half of true reactions. Most patients with codes 693.0, 995.1, 708, and 995.0 had allergic drug reactions, with 693.0 as the highest yield code. An aggregate of multiple specific codes consistently identifies a cohort of patients with confirmed allergic drug reactions.
由于识别和确认病例的挑战，过敏药物反应的研究受到限制。
确定国际疾病分类，第九修订版，临床修正（ICD-9-CM）代码用于识别住院过敏药物反应的效用，并将结果与之前在急诊室的数据进行比较。
通过审查大型城市学术医疗中心的 ICD-9-CM 代码和提示过敏药物反应的 E 代码的住院患者的医疗记录，我们确定了产生最多药物过敏病例的代码，并确定了罪魁祸首药物。
在 2005 年和 2010 年，分别确定了 3337 例和 5282 例可能的住院过敏药物反应，并对 1367 例进行了回顾。在审查的图表中发现过敏药物反应 409 例（30.1%），其中 2005 年为 172 例（29.7%），2010 年为 237 例（30.5%）。识别出最高比例的真实过敏药物反应的代码是药物性皮炎（693.0），过敏性荨麻疹（708），血管神经性水肿（995.1）和过敏反应（995.0）。抗生素是最常见的原因（44.4%）; 然而，通常确定多种药物类别为可能的罪魁祸首药物。
特定的 ICD-9-CM 代码可以识别出过敏药物反应的患者，抗生素占真实反应的近一半。大多数具有代码 693.0，995.1，708 和 995.0 的患者有过敏药物反应，其中 693.0 是最高产量代码。多个特定代码的总和可确定一组确诊的过敏药物反应患者。
