Disposition of emergency department patients presenting with angiotensin-converting enzyme inhibitor-induced angioedema

Abstract

Abstract Background Angiotensin-converting enzyme inhibitors (ACEI) are the most common cause of drug-induced angioedema in the United States (US). Our primary objective was to provide descriptive evidence regarding ED disposition of ACEI-induced angioedema patients. Our secondary objective was to evaluate unique patterns in those with ACEI-induced angioedema at a tertiary referral center. Methods This was a retrospective study evaluating all cases of ACEI-induced angioedema at a large, regional academic medical center. We performed a medical record review to identify patients with ACEI-induced angioedema who presented to the ED from January 1, 2016, to December 31, 2022. A total of 637 unique patient encounters met potential inclusion. After a substantial, standardized review, 94 patients met inclusion. Results During the study period, there were 94 patients presenting to the ED who were diagnosed as having angioedema secondary to an ACEI (90 patients) or ARB (4 patients). The only treatment found to have statistical association with disposition was intramuscular (IM) epinephrine. Overall, 53 patients (56.38%) improved during their ED stay, and of those, 32 patients (60.38%) were discharged home. None of the 12 patients that worsened were sent home from the ED. Only thirteen of 43 ED discharged patients (23.64%) had their ACEI/ARB documented in their allergy listings compared to 42 of 51 patients (76.36%) of admitted patients, p < 0.0001, odds ratio of failure to document was 0.0929 (95% CI, 0.0352 to 0.24512). Only one patient out of the total 94 returned to the ED during our study period and was subsequently discharged. Conclusion Our results indicate that at a large, tertiary care referral center, carefully selected patients with ACEI-angioedema were safely discharged home with low risk of return visit to the ED within 72 hours. No particular symptom or sign predicted the need for intubation, but those who were discharged from the ED with a median stay of 4 hours had no increased risk of return to the ED versus those who were admitted. Further, among those admitted, patients in our study had a short inpatient stay and were safely discharged with no documented early return visit to the ED.