Accuracy for registration of disease codes in pediatric anaphylaxis

Yeon Joo Cho; Sun Hyu Kim; Hyeji Lee; Byungho Choi; Mi Jin Kim; Jung Seok Hong

doi:10.4168/aard.2017.5.3.159

Journal List > Allergy Asthma Respir Dis > v.5(3) > 1059251

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Cho, Kim, Lee, Choi, Kim, and Hong: Accuracy for registration of disease codes in pediatric anaphylaxis

Original Article

Allergy Asthma Respir Dis 2017;5(3):159-164.

Published online: 5 May 2017

DOI: https://doi.org/10.4168/aard.2017.5.3.159

Accuracy for registration of disease codes in pediatric anaphylaxis

Yeon Joo Cho, Sun Hyu Kim, Hyeji Lee, Byungho Choi, Mi Jin Kim, Jung Seok Hong

Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Correspondence to: Sun Hyu Kim https://orcid.org/0000-0002-4836-0940 Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan 44033, Korea Tel: +82-52-250-8405, Fax: +82-52-250-8071, E-mail: stachy1@paran.com

Received 9 February 201713 March 2017 Accepted 17 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to survey the accuracy of registration as anaphylaxis codes and the clinical characteristics of anaphylaxis registered correctly and incorrectly in pediatric anaphylaxis.

Methods

This study was conducted retrospectively using the medical records of patients under 15 years who visited a training hospital Emergency Department (ED) for 5 years. The study subjects were divided into the correct group (registered as anaphylaxis codes correctly) and the incorrect group (registered as other anaphylaxis related codes).

Results

Of the 133 patients, 14 belonged to the correct group and 119 to the incorrect group. The median age of the correct group was 9 years old and that of the incorrect group was 2 years old. Sex, transportation to the ED, elapsed time from exposure to ED arrival, past history of allergy, causes of anaphylaxis except drug, severity of symptom, mental status, and antihistamine use were not different between the 2 groups. Drugs as the cause of anaphylaxis and cardiovascular/neurologic symptoms were more common in the correct group. Gastrointestinal symptoms were more frequent in the incorrect group. Intravenous fluid, steroid, bronchodilator, and epinephrine were more commonly used as the treatment for anaphylaxis in the correct group. The pediatric patients treated with epinephrine tended to be registered anaphylaxis correctly.

Conclusion

More patients were registered incorrectly as other anaphylaxis-related disease codes rather than correctly as the anaphylaxis disease codes in pediatric anaphylaxis. Epinephrine use was the associated factor for being registered correctly as the anaphylaxis disease codes in pediatric anaphylaxis.

Keywords: Anaphylaxis, Pediatrics, Accuracy

REFERENCES

1. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004; 113:832–6.

2. Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report–Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006; 117:391–7.

3. Techapornroong M, Akrawinthawong K, Cheungpasitporn W, Ruxrung- tham K. Anaphylaxis: a ten years inpatient retrospective study. Asian Pac J Allergy Immunol. 2010; 28:262–9.

4. Lim DH. Epidemiology of anaphylaxis in Korean children. Korean J Pediatr. 2008; 51:351–4.

5. Sicherer SH, Sampson HA. Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol. 2014; 133:291–307.

6. McGowan EC, Keet CA. Prevalence of self-reported food allergy in the National Health and Nutrition Examination Survey (NHANES) 2007-2010. J Allergy Clin Immunol. 2013; 132:1216–9.e5.

7. Oh JW, Pyun BY, Choung JT, Ahn KM, Kim CH, Song SW, et al. Epidemiological change of atopic dermatitis and food allergy in school-aged children in Korea between 1995 and 2000. J Korean Med Sci. 2004; 19:716–23.

8. Simons FE, Sampson HA. Anaphylaxis epidemic: fact or fiction? J Allergy Clin Immunol. 2008; 122:1166–8.

9. Dinakar C. Anaphylaxis in children: current understanding and key issues in diagnosis and treatment. Curr Allergy Asthma Rep. 2012; 12:641–9.

10. Rudders SA, Banerji A, Corel B, Clark S, Camargo CA Jr. Multicenter study of repeat epinephrine treatments for food-related anaphylaxis. Pediatrics. 2010; 125:e711–8.

11. Brown SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol. 2004; 114:371–6.

12. Park HM, Noh JC, Park JH, Won YK, Hwang SH, Kim JY, et al. Clinical features of patients with anaphylaxis at a single hospital. Pediatr Allergy Respir Dis. 2012; 22:232–8.

13. Jin HJ. Anaphylaxis: diagnosis, management, and current barriers. Allergy Asthma Respir Dis. 2016; 4:79–81.

14. Kim WK. Diagnosis and treatment of food allergy in children. Pediatr Allergy Respir Dis. 2006; 16:274–83.

15. Nam SY. Food allergy; diagnosis and treatment. Pediatr Allergy Respir Dis. 2004; 14:119–26.

16. Braganza SC, Acworth JP, Mckinnon DR, Peake JE, Brown AF. Paediatric emergency department anaphylaxis: different patterns from adults. Arch Dis Child. 2006; 91:159–63.

17. Kelso JM. Pediatric emergency department anaphylaxis: different patterns from adults. Pediatrics. 2007; 120(Supplement 3):S121.

18. Brown SG, Blackman KE, Stenlake V, Heddle RJ. Insect sting anaphylaxis; prospective evaluation of treatment with intravenous adrenaline and volume resuscitation. Emerg Med J. 2004; 21:149–54.

19. Seo DH, Ye YM, Kim SC, Ban GY, Kim JH, Shin YS, et al. A single hospital survey of anaphylaxis awareness among health care providers and medical students. Allergy Asthma Respir Dis. 2016; 4:133–9.

20. Ye YM, Kim MK, Kang HR, Kim TB, Sohn SW, Koh YI, et al. Predictors of the severity and serious outcomes of anaphylaxis in korean adults: a multicenter retrospective case study. Allergy Asthma Immunol Res. 2015; 7:22–9.

21. Tejedor Alonso MA, Moro Moro M, Múgica García MV. Epidemiology of anaphylaxis. Clin Exp Allergy. 2015; 45:1027–39.

22. Koplin JJ, Martin PE, Allen KJ. An update on epidemiology of anaphylaxis in children and adults. Curr Opin Allergy Clin Immunol. 2011; 11:492–6.

Fig. 1.

The patient number of anaphylaxis registered correctly and incorrectly.

Table 1.

International Statistical Classification of Diseases 10th Revision (ICD-10) codes related anaphylaxsis

Code	ICD-10 code
Anaphylaxis codes
Anaphylaxis	T78.2B, T78.2C
Anaphylactic shock	T78.0, T78.2,T88.6
Other related codes
Allergy	T78.4, T78.4A, T78.4B
Food allergy	T78.1
Drug allergy	T88.7, T88.7B, T88.7C, T88.7D, T88.7E, Z88
Insect bite	S-codes, T14.0G, T63.4A, W57, X23
Angioedema	T78.3
Urticaria	L28.2C, L50.0, L50.88, L50.9

Table 2.

General characteristics of anaphylaxis registered correctly and incorrectly

Characteristic	Correct (n=14)	Incorrect (n=119)	P-value
Age (yr)	9 (1.8–12.5)	2 (0.7–9.0)	0.025∗
Age group (yr)			0.117
<1	2 (14.3)	45 (37.8)
1–7	4 (28.6)	37 (31.1)
≥7	8 (57.1)	37 (31.1)
Male sex	6 (42.9)	69 (58.0)	0.280
Transportation to ED			0.254
Public ambulance	2 (14.3)	6 (5.0)
Other medical facility	1 (7.1)	6 (5.0)
Individual transportation	11 (78.6)	107 (89.9)
Elapsed time from (min)
Exposure to symptom onset	10 (5–65)	30 (5–120)	0.402∗
Symptom onset to ED arrival	110 (57–180)	120 (60–360)	0.391∗
Past history of allergy	8 (57.1)	42 (35.3)	0.110
Anaphylaxis	1 (7.1)	1 (0.8)	0.200
Asthma	0 (0)	3 (2.5)	1.000
Allergic rhinitis	1 (7.1)	4 (3.4)	0.432
Atopic dermatitis	4 (28.6)	12 (10.1)	0.067
Drug allergy	0 (0)	3 (2.5)	1.000
Food allergy	3 (9.0)	25 (13.9)	1.000
Comorbidity	1 (7.6)	5 (4.2)	0.494

Values are presented as median (interquatile range) or number (%). ED, Emergency Department.

^∗ Mann-Whitney U-test.

Table 3.

Causes of anaphylaxis registered correctly and incorrectly

Variable	Correct (n=14)	Incorrect (n=119)	P-value
Drug	5 (35.7)	13 (10.9)	0.024
NSAIDs	1 (7.1)	3 (2.5)	0.363
Penicillin	2 (14.3)	0 (0)	0.010
Cephalosporin	2 (14.3)	1 (0.8)	0.029
Vaccine	0 (0)	2 (1.7)	1.000
Acetaminophen	1 (7.1)	3 (2.5)	0.363
Insect sting	0 (0)	1 (0.8)	1.000
Food	7 (50.0)	86 (72.3)	0.121
Sea food	2 (14.3)	14 (11.8)	0.676
Wheat	0 (0)	7 (5.6)	1.000
Buckwheat	0 (0)	3 (2.5)	1.000
Pupa	0 (0.0)	2 (1.7)	1.000
Nut	2 (14.3)	5 (4.2)	0.159
Egg	3 (21.4)	16 (13.4)	0.422
Pork	0 (0)	3 (2.5)	1.000
Cow milk	1 (7.1)	29 (24.4)	0.190
Idiopathic	1 (7.1)	15 (12.7)	1.000

Values are presented as number (%). NSAID, nonsteroidal anti-inflammatory drug.

Table 4.

Clinical characteristics of anaphylaxis registered correctly and incorrectly

Characteristic	Correct (n=14)	Incorrect (n=119)	P-value
Symptoms
Cutaneous	13 (92.9)	118 (99.2)	0.200
Respiratory	10 (71.4)	53 (44.5)	0.088
Cardiovascular	6 (42.9)	1 (0.8)	<0.001
Gastrointestinal	2 (14.3)	70 (58.8)	0.003
Neurologic	2 (14.3)	1 (0.8)	0.029
Blood pressure (mmHg)
Systolic blood pressure	105 (96–127)	98 (95–106.5)	0.155§
Diastolic blood pressure	72.5 (63.8–80)	61 (55.5–70)	0.017∗
Severe symptoms	2 (14.3)	2 (1.7)	0.055
Nonalert consciousness	1 (7.1)	0 (0.0)	0.105
ED treatment
O₂ supply	2 (14.3)	4 (3.4)	0.121
Fluid administration	13 (92.9)	41 (34.5)	<0.001
Antihistamine use	12 (85.7)	112 (94.1)	0.241
Steroid use	9 (64.3)	36 (30.3)	0.016
Epinephrine use	8 (57.1)	17 (14.3)	0.001
Bronchodilator use	6 (42.9)	18 (15.1)	0.021

Values are presented as median number (%) or (interquatile range). ED, Emergency Department.

^∗ Mann-Whitney U-test.

Table 5.

Univariate and multivariate logistic regression analysis for factors associated with anaphylaxis registered correctly

Variable	Odds ratio	95% Confidence interval	P-value
Univariate logistic regression
Age	1.122	1.009–1.247	0.033
Drug, as anaphylaxis cause	4.530	1.317–15.586	0.017
Cardiovascular symptom	88.500	9.470–827.018	0.001
Gastrointestinal symptom	0.117	0.025–0.545	0.006
Neurologic symptom	19.667	1.659–233.166	0.018
Diastolic blood pressure	1.050	1.009–1.094	0.018
Fluid administration	24.732	3.125–195.758	0.002
Steroid use	4.150	1.300–13.253	0.016
Epinephrine use	8.000	2.467–25.943	0.001
Bronchodilator use	4.208	1.304–13.576	0.016
Multivariate logistic regression
Epinephrine use	5.614	1.483–21.249	0.011

TOOLS

Similar articles