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

angioedema

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

angioedema

Angioedema, ACEI-angioedema, Epinephrine, Airway, Emergency department boarding

Abstract
Background Angiotensin-converting enzyme inhibitors (ACEI) are the most common cause of drug-induced
angioedema in the United States. Our primary objective was to provide descriptive evidence regarding emergency
department (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, including demographics, details of those
requiring intubation, length of inpatient stay, and allergy documentation.
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 structured data abstraction process was
utilized to select patients of interest, followed by descriptive statistics, chi-square tests and odds ratios for categorical
data, and Kruskal Wallis tests for continuous data.
Results A total of 637 unique patient encounters met potential inclusion. After a substantial, standardized review, 94
patients met inclusion. 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 angiotensin receptor blocker (ARB) (4 patients). 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. Those who were discharged from the ED with a median
stay of 4 h had no increased risk of return to the ED versus those who were admitted. The only treatment found to
have statistical association with disposition was intramuscular epinephrine. Only 13 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, 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 due to recurrent angioedema symptoms during our study period and was subsequently
discharged.

Blake Briggs1*, David Cline2

and Iltifat Husain2

https://doi.org/10.1186/s12245-024-00772-5

2025

Peri Irawan

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