Choi Byungho, Kim Sun Hyu, Lee Hyeji
Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Republic of Korea.
Emerg Med Int. 2019 Aug 14;2019:4198630. doi: 10.1155/2019/4198630. eCollection 2019.
It is important to register anaphylaxis codes correctly to study the exact prevalence of anaphylaxis. The purpose of this study was to analyze the clinical characteristics and disease codes of inaccurately registered groups in pediatric anaphylaxis patients.
This study reviewed the medical records of all pediatric patients who presented to the university hospital emergency department over a 5-year period. Study subjects were divided into 2 groups: the accurate group, including those registered under anaphylaxis codes, and the inaccurate coding group, including those registered under other codes.
From a total of 79,676 pediatric patients, 184 (0.23%) had anaphylaxis. Of these, 23 (12.5%) and 161 (87.5%) patients were classified to the accurate and inaccurate coding groups, respectively. Average age, time from symptom onset to emergency department presentation, past history of allergy, and penicillin and cephalosporin as causes of anaphylaxis differed between the 2 groups. Cardiovascular (39.1% vs. 5.6%, =0.001) and respiratory symptoms (65.2% vs. 42.2%, =0.038) manifested more frequently in the accurate group, while gastrointestinal symptoms (68.3% vs. 26.1%, =0.001) were more frequently observed in the inaccurate coding group. Fluid administration (82.6% vs. 28.0%, =0.001), steroid use (60.9% vs. 23.0%, =0.001), and epinephrine use (65.2% vs. 13.0% =0.001) were more common treatments for anaphylaxis in the emergency department in the accurate group. Anaphylaxis patients with cardiovascular symptoms, steroid use, and epinephrine use were more likely to be accurately registered with anaphylaxis disease codes.
In the case of pediatric anaphylaxis, more patients were registered inaccurately under other allergy-related codes and simple symptom codes, rather than under anaphylaxis codes. Therefore, future research on anaphylaxis should consider inaccurately registered anaphylactic patients, as shown in this study.
正确登记过敏反应编码对于研究过敏反应的确切患病率很重要。本研究的目的是分析儿科过敏反应患者中编码不准确组的临床特征和疾病编码。
本研究回顾了5年间在大学医院急诊科就诊的所有儿科患者的病历。研究对象分为2组：准确组，包括那些按照过敏反应编码登记的患者；编码不准确组，包括那些按照其他编码登记的患者。
在总共79676名儿科患者中，184名（0.23%）发生了过敏反应。其中，分别有23名（12.5%）和161名（87.5%）患者被归类到准确编码组和编码不准确组。两组在平均年龄、从症状出现到急诊科就诊的时间、过敏史以及作为过敏反应原因的青霉素和头孢菌素方面存在差异。心血管症状（39.1%对5.6%，P=0.001）和呼吸道症状（65.2%对42.2%，P=0.038）在准确组中更频繁出现，而胃肠道症状（68.3%对26.1%，P=0.001）在编码不准确组中更常被观察到。在急诊科，准确组中输液（82.6%对28.0%，P=0.001）、使用类固醇（60.9%对23.0%，P=0.001）和使用肾上腺素（65.2%对13.0%，P=0.001）是更常见的过敏反应治疗方法。有心血管症状、使用类固醇和使用肾上腺素的过敏反应患者更有可能被准确登记为过敏反应疾病编码。
在儿科过敏反应病例中，更多患者是按照其他与过敏相关的编码和简单症状编码登记不准确，而非按照过敏反应编码登记。因此，如本研究所示，未来关于过敏反应的研究应考虑编码不准确的过敏反应患者。
