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Inaccurate diagnosis of paediatric anaphylaxis in three Australian Emergency Departments
Author(s) -
Thomson Hector,
Seith Robert,
Craig Simon
Publication year - 2017
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.13483
Subject(s) - medicine , anaphylaxis , emergency department , triage , confidence interval , odds ratio , pediatrics , retrospective cohort study , allergy , emergency medicine , immunology , psychiatry
Aim To determine the accuracy of emergency department ( ED ) paediatric anaphylaxis diagnosis, and to identify factors associated with misdiagnosis. Methods Retrospective chart review of children aged 0–18 years with allergic presentations to three Victorian EDs in 2014. Cases were included if an ED diagnosis of anaphylaxis was recorded, or the presentation met international consensus criteria for anaphylaxis. Results Of the 60 143 paediatric ED presentations during the study period, 1551 allergy‐related presentations were identified and reviewed. One hundred and eighty‐seven met consensus criteria for anaphylaxis, and another 24 were diagnosed with anaphylaxis without meeting criteria. Of the 211 presentations, 105 cases were given an ED diagnosis of anaphylaxis and 106 cases were given an alternative diagnosis in ED . ED assessment had a sensitivity of 43.2% (95% confidence interval ( CI ) 36.1–50.7%) and specificity of 97.9% (95% CI 96.9–98.7%) for anaphylaxis. Multiple logistic regression demonstrated that an ED anaphylaxis diagnosis was associated with previous anaphylaxis (odds ratio ( OR ) 3.20; 95% CI 1.52–6.75), arrival by ambulance ( OR 2.80; 95% CI 1.36–5.74), a high‐acuity triage category ( OR 4.51; 95% CI 2.20–9.25) and presentation to a tertiary hospital ( OR 2.86; 95% CI 1.44–5.67). ED diagnosis of anaphylaxis was less likely in those with resolution of symptoms and signs in at least one organ system prior to arrival ( OR 0.27; 95% CI 0.12–0.62). Conclusion In children with allergic presentations, ED assessment has a low sensitivity but high specificity for anaphylaxis. Attention to resolved pre‐hospital symptoms and awareness of diagnostic criteria are important considerations for accurate ED diagnosis of anaphylaxis.