Underdiagnosis and undertreatment of anaphylactic patients at the emergency department

Oldenburger, T.R.G. (Thomas) (2017) Underdiagnosis and undertreatment of anaphylactic patients at the emergency department. thesis, Medicine.

Text OldenburgerTRG.pdf Restricted to Registered users only Download (887kB)

Abstract

Introduction Anaphylaxis is a serious, allergic reaction that is rapid in onset and may cause death. Rapid administration of adrenalin can be life saving for anaphylactic patients. Adrenalin is the treatment of choice for respiratory and cardiovascular symptoms, and it has a role in the prevention of degranulation of mast cells. Multiple studies have reported underdiagnosis and undertreatment for anaphylactic patients. In 2005 experts from different allergy organisations proposed diagnostic criteria of anaphylaxis: the National Institute of Allergy and Infectious disease, and Food Allergy and Anaphylaxis Network criteria (NIAID/FAAN criteria). These criteria have been found valuable for clinical practise. Aims To retrospectively analyse the diagnosis and treatment of anaphylactic patients with the use of the NIAID/FAAN criteria at the emergency department (ED) of two teaching hospitals in Amsterdam, the Netherlands. Methods All patients that visited the ED of the OLVG oost and OLVG west between 01-01-2015 and 31-12-2016 with any form of an allergic reaction were included in this study. The included patients were retrospectively analysed and it was checked if they fulfilled the NIAID/FAAN. The diagnosis given by the treating physician was compared with the outcome of the criteria. Furthermore the treatment of the anaphylactic patients was checked by the administration of adrenalin, the admission to a hospital inpatient department and the (observation) time these patients spent at the ED. Result In total 548 patients were included in this study. 246 (44.9%) of the 548 patients met the NIAID/FAAN criteria. 141 (57.3%) of these anaphylactic patients were given a diagnosis by the treating physician at the ED suggesting a milder allergic reaction. 90 (36.6%) anaphylactic patients did not receive adrenalin as a treatment. 33 (13.5%) anaphylactic patients were admitted to a hospital inpatient department. The median time the not-admitted anaphylactic patients spent at the ED was 2:52 hour. Conclusion This study demonstrates that 57.3% of anaphylactic patients were underdiagnosed and 36.6% of the anaphylactic patients were undertreated at the ED. The results indicate the diagnosis and treatment of anaphylactic patients must be improved, especially since adrenalin administration can be life saving.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty tutor: and Duits, prof. A.J. and Sint Elisabeth Hospital, Curacao and University Medical Centre Groningen
Supervisor name:	Supervisor: and Sandel, dr. M.H. and Location: OLVG, Amsterdam and Department: Emergency Department
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:00
Last Modified:	25 Jun 2020 11:00
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2069

Actions (login required)

View Item