Jiaci

31 / 80

Epidemiology of Anaphylaxis in French Emergency Departments
J Investig Allergol Clin Immunol 2019; Vol. 29(5): 357-364 © 2019 Esmon Publicidad
doi: 10.18176/jiaci.0348
Introduction
Anaphylaxis is an acute, severe, life-threatening generalized
or systemic hypersensitivity reaction that requires rapid
recognition and treatment [1]. It may present as very different
combinations of symptoms, and apparently mild signs may
unpredictably progress to fatal shock. The recognition of
anaphylaxis is hampered, in part, by variability in diagnostic
criteria. Consequently, administration of appropriate treatment
is delayed, thus increasing the risk of death. Anaphylaxis is a
recognized cause of death in all age groups.
Although this condition is considered a priority public
health issue in the world allergy community, epidemiological
data on morbidity and mortality remain suboptimal. The
frequency of anaphylaxis in the emergency department
(ED) has been reported to range from 0.04% to 0.5% of
visits [2-10]. This remarkable variability is related to factors
such as differences between populations and EDs, difficulty
recognizing at-risk and anaphylactic patients, and the
methodology applied to calculate rates.
In 2017, Tanno et al [1] reported a local incidence rate
of 32 per 100 000 person-years in hospitalized patients
in Montpellier, France [11] and a national mortality rate
of 0.83 (0.80-0.88) [12]. However, there are currently no
epidemiological studies on the morbidity of anaphylaxis in
French EDs.
Ascertaining how anaphylaxis is diagnosed and treated
nationally and worldwide is an important preliminary step
towards the development of public health strategic action
plans to identify and resolve key issues. We proposed a 1-year
multicenter epidemiological study in 7 French EDs covering a
population of 953 552 inhabitants in order to identify key areas
for change and to support ongoing national and international
efforts for better diagnosis, management, and prevention of
anaphylaxis.
Methods
Data Sources and Case Definition
Ours was a descriptive study using ED data routinely
reported to French institutional administrative databases.
The French public hospital structure uses a system of
coding alongside the length of hospital stay to determine
the chargeable cost of care per patient for purposes of
reimbursement. The coding system used is the World Health
Organization (WHO) International Classification of Diseases
(ICD), currently ICD-10 [13]. Coding is based on review of
case reports by professional coders, who take into account
diagnosis, procedures, and other events reported by the care
team. The data are submitted to be included in national health
statistics and are used for research and planning. Since French
public health institutions serve as references for patients in the
regions where they located, patients are generally referred to
these hospitals.
In this study, we evaluated data from 7 EDs in institutions
from the University of the Lorraine urban region between
January and December 2015. Data were retrieved in January
2016. Lorraine is an administrative area in the northeast of
France with 32 public healthcare institutions of different
complexities.
Of the 202 079 ED admissions recorded during the year
2015, we accessed all consecutive files in which the primary
solo en el 32,4% de estos casos. En total, 323 casos, el 57,9%, se remitieron posteriormente para un estudio o evaluación alergológica
(después o durante la hospitalización) y el 17,3% recibió una receta de adrenalina autoinyectable.
Conclusión: Según los resultados de este estudio, existe una necesidad urgente e imperiosa de mejorar los planes de salud pública
respecto al reconocimiento y tratamiento de la anafilaxia. Los problemas clave detectados en este trabajo, señalan el camino de la toma de
decisiones e implementación de acciones de mejora, nacionales e internacionales, para una mejor atención de los pacientes con anafilaxia.
Palabras clave: Anafilaxia. Urgencias. Epidemiología. Clasificación Internacional de Enfermedades (CIE). Tratamiento.
Figure. Flow chart showing patient selection and inclusion based on the
International Classification of Diseases.
Total population = 953 552 (2015)
Number of cases related to direct
anaphylaxis codes = 46
(T78.0 = 10; T78.2 = 36;
T80.5 = 0; T88.6 = 0;
T63.4 = 0)
Number of cases related to
indirect anaphylaxis codes = 277
(J38.4 = 5; J39.3 = 7; J45.0 =2;
J45.9 = 2; L23.9 = 1;
L50.0 = 26; L50.9 = 46;
R60.9 = 1; T63.4 = 1;
T78.3 = 5; T78.4 = 181)
Total admissions/year from 2015/01/01
to 2015/12/31 in the 7
EDs included = 202 079
Total cases selected based on the
95 ICD-10 anaphylaxis-related
codes = 4817
Exclusions after clinical
validation (incomplete
files, incompatibility with
anaphylaxis diagnostic
criteria, doubtful
cases) = 4494
Total cases clinically selected as
anaphylaxis = 323
358