Incidence and Factors associated with Misdiagnosis of Anaphylaxis
Keywords:
Anaphylaxis, diagnosis, symptom, allergen, epinephrineAbstract
Background: Anaphylaxis is a serious life-threatening condition that is rapid in onset. The incidence tends to be increasing with the different symptoms in population. Misdiagnosis and improper medical care, which in turn, would affect to a worsening condition.
Objective: To study the incidence, characteristic, causes, and factors influencing the misdiagnosis of anaphylaxis in Chaoprayayommarat Hospital, Thailand.
Methods: We performed a retrospective analytic study, based on ICD-10 electronic medical records of anaphylaxis patients in the Chaoprayayommarat Hospital from January 2019 to August 2021.
Result: A total of 350 episodes of anaphylaxis in 332 patients was analyzed, following by 137 episodes of misdiagnosis (39.1%) and overdiagnosis (80%) which is frequently found in Forty-six episodes (42%) of children. The incidence rate was 0.19%; essentially in male (52%). The median age was 24.5 years. Cutaneous manifestations were the most common presentation (93.7%). The main cause was mostly from food(56.3%). The factor affecting misdiagnosis, for instance; skin and mucosa system (aOR,0.07; 95%CI= 0.02-0.23; P=0.01), respiratory system (aOR,0.04; 95%CI= 0.02-0.09; P<0.001), Gastrointestinal symptom (aOR,0.09; 95% CI, 0.05-0.18;P<0.001), unknown of allergen (aOR,8.6; 95% CI, 1.2- 65.1;P=0.04), Out-patient diagnosis (aOR,10.7; 95% CI, 1.1-103.4;P=0.04) and Diagnose by Pediatricians (aOR,5.8; 95% CI, 1.04-31.9;P=0.04). The respiratory system were significantly associated with misdiagnosis in children (aOR, 0.05; 95% CI, 0.01- 0.19;P<0.001). Most of the patients were prescribed by Epinephrine injections (90.6%).
Biphasic reactions occurred in 44 patients (12.6%).
Conclusion: The Incidence of anaphylaxis in Chaoprayayommarat Hospital was found similar to that of other hospitals, which more common in young adult. Overdiagnosis were mostly about of misdiagnosis. Manifested symptoms, unknown allergen and place of
diagnosis were significantly factors of misdiagnosis with an inappropriate management and follow-up. Therefore, the proper Anaphylactic guideline should be contributed in order to management and prevention
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