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Abstract:
Recent studies based on hospital admissions have reported a significant increase in anaphylaxis prevalence. These studies rely on accurate diagnosis and coding data from medical records, which has been identified as a potential shortcoming.1-3 The aim of this study was to investigate the extent of anaphylaxis miscoding, how this changed after intensified training programs and new anaphylaxis guidelines, and whether this contributed to apparent changes in prevalence over a 10-year period. This also provided an opportunity to examine changes in characteristics of the presenting cases (age and triggers) over time. We conducted a detailed retrospective chart examination of all cases coded as anaphylaxis presenting to the main tertiary Pediatric Emergency Department (PED) in Perth, Australia, where all coding is performed by medical staff. We compared data from 2003-2004 (period 1), when International Classification of Diseases, Tenth Revision codes commenced, with data from 2012 (period 2), after intensified training programs and new anaphylaxis guidelines were introduced. All cases (aged 0-16 years) coded as anaphylaxis were independently reviewed by 2 specialist allergists/clinical immunologists. We used criteria from the 2006 Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium for the definition and management of anaphylaxis.4 Information was collected on standardized forms. This yielded 136 cases from period 1 (from a total of 83,832 presentations to the PED for 2003-2004) and 177 cases from period 2 (from a total of 71,822 presentations for 2012).