Underdiagnosis of anaphylaxis in the emergency department: misdiagnosed or miscoded?

Underdiagnosis of anaphylaxis in the emergency department: misdiagnosed or miscoded? Hilal Hocagil, Evvah Karakilic, Cuneyt Hocagil, Huleyde Senlikci, Fatih Buyukcam Department of Emergency Medicine, Dr Lutfi Kırdar Kartal Education and Research Hospital, Istanbul, Turkey Objectives. To distinguish allergic reactions and anaphylaxis, and to highlight the importance of anaphylaxis. Design. Case series. Setting. Adult emergency department of the medical faculty of Hacettepe University, Ankara, Turkey. Patients. Adults admitted to the emergency department between 1 May 2005 and 30 April 2010 with allergic diseases considered to be anaphylaxis or anaphylactic reactions. Main outcome measures. Patient age, gender, possible cause(s) of allergy, organ involvement, treatment, and physical examination findings. Results. Although recorded physical examination findings of patients were consistent with anaphylaxis, 88 patients were not diagnosed as having this condition. All patients in this study group were evaluated in the emergency department facility and did not consult or were not referred to any other department or specialist. In all, 79 (90%) of them were discharged in the first 12 hours, 5 (6%) after 12 to 24 hours, and 4 (5%) after 24 hours. None of these patients died. Conclusion. Emergency physicians should be better able to recognise the clinical features of anaphylaxis, so as to treat the episode promptly and appropriately. Delay in diagnoses could lead to incomplete treatment and even be fatal. Hong Kong Med J 2013;19:Epub 2013 May 20   |  DOI: 10.12809/hkmj133895 Key words: Anaphylaxis; Diagnosis; Emergency service, hospital