Allergy Asthma Immunol Res.  2018 Mar;10(2):137-143. 10.4168/aair.2018.10.2.137.

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

• Choi B
• Kim SH
• Lee H

• KMID: 2402973
• DOI: http://doi.org/10.4168/aair.2018.10.2.137

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.

Keyword

Anaphylaxis; international classification of disease codes; emergency department

MeSH Terms

Adult*
Anaphylaxis*
Clinical Coding
Consciousness
Emergencies*
Emergency Service, Hospital*
Epinephrine
Humans
International Classification of Diseases
Intubation
Medical Records
Neurologic Manifestations
Oxygen
Retrospective Studies
Transportation
Epinephrine
Oxygen

Figure

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  Figure The numbers of accurately and inaccurately registered anaphylaxis patients. We excluded patients (a) without ICD-10 codes that are associated with anaphylaxis (anaphylaxis, anaphylaxis-related, and symptom-related codes). We further excluded (b) patients with allergy- and symptom-related codes who did not satisfy the diagnostic criteria of anaphylaxis patients among those with ICD-10 codes associated with anaphylaxis.

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