Child sexual assault presentations to a tertiary paediatric metropolitan hospital

nician diagnosis of “anaphylaxis”, “allergic reaction” or “reaction (other)” was recorded. Outcome measures included rate of correct anaphylaxis diagnosis in terms of missed anaphylaxis diagnosis (meeting study criteria for an anaphylaxis diagnosis but clinicians did not diagnose anaphylaxis) and overdiagnosis (clinicians diagnosing anaphylaxis where diagnostic criteria were not met). Statistical Analyses: For continuous variables, Student’s T-test was used to compare the difference between groups for normally distributed data and the Mann-Whitney (ranksum) test used for non-normally distributed data. Chi-squared or Fisher’s exact test was used to compare groups for categorical variables. Multivariable logistic regression analysis was conducted to identify independent predictors of incorrect diagnosis. Stata version 15.1 (StataCorp, College Station, Texas, USA) was used for the statistical analysis. Results: Of 314,713 presentations to ED during the examined period, 2,294 met inclusion criteria. 551/601 (91.7%) diagnosed with anaphylaxis by clinicians met study criteria for anaphylaxis diagnosis and 274/1,693 (16.2%) were diagnosed with nonanaphylaxis by clinicians but met study criteria for anaphylaxis. Those meeting criteria for anaphylaxis were more likely to receive adrenaline if they received a diagnosis of anaphylaxis (89.7% compared to 80%, P<0.001). Children under 5 years were most likely to have a missed anaphylaxis diagnosis (odds ratio 3.26, 95%CI 1.6-6.6, P=0.001). Children were more likely than adults to be misdiagnosed with food anaphylaxis if they had only gastrointestinal, or gastrointestinal and dermatological features (2.3% of children compared to 0.6% of adults). Consultant physicians had a higher sensitivity for anaphylaxis diagnosis compared to junior doctors (76.1% vs. 60.2% respectively, P<0.001)with the greatest difference in diagnosis for the subgroup of children aged 0-5 years (reacting to food allergens (86.2% vs. 58.6% respectively, P=0.014). Conclusion: In those presenting to ED for allergy or anaphylaxis, many patients with anaphylaxis are misdiagnosed and receive incomplete treatment. Awareness of different types of anaphylaxis presentations, such as those without dermatological involvement, is a potential educational opportunity to improve the rate of diagnosis. References: 1. Liew, W, Williamson, E and Tang, M. (2009). Anaphylaxis fatalities and admissions in Australia. Journal of Allergy and Clinical Immunology, 123(2), pp.434-442. 2. Thomson, H, Seith, R and Craig, S. (2017). Inaccurate diagnosis of paediatric anaphylaxis in three Australian Emergency Departments. Journal of Paediatrics and Child Health, 53(7), pp.698-704.