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The following is a summary of “Disposition of emergency department patients presenting with angiotensin-converting enzyme inhibitor-induced angioedema,” published in the January 2025 issue of Emergency Medicine by Briggs et al. 

Angiotensin-converting enzyme inhibitors (ACEIs) have been recognized as a leading cause of drug-induced angioedema in the United States.  

Researchers conducted a retrospective study to describe the emergency department (ED) disposition and clinical characteristics, including intubation rates, length of stay, and allergy documentation, of patients with ACEI-induced angioedema at a tertiary referral center.  

They reviewed medical records of ACEI-induced angioedema cases at a large regional academic medical center. Cases presented to the ED between January 1, 2016, and December 31, 2022, were identified through a structured data abstraction process. Analyses included descriptive statistics, chi-square tests, odds ratios for categorical data, and Kruskal-Wallis tests for continuous data.  

The results showed 637 unique encounters were screened, with 94 individuals meeting inclusion criteria after review. Of these, 90 were diagnosed with angioedema due to ACEIs and 4 due to angiotensin receptor blockers (ARBs). Among the 94 cases, 56.38% (53 individuals) improved during ED stay, and 60.38% (32 individuals) of those were discharged home. None of the 12 individuals whose condition worsened were discharged from the ED. The median ED stay for those discharged was 4 hours, with no increased risk of ED return compared to admitted individuals. Intramuscular epinephrine was the only treatment significantly associated with disposition. ACEI/ARB allergy documentation occurred in 23.64% (13 of 43) of discharged individuals vs 76.36% (42 of 51) of admitted individuals, with an odds ratio of 0.0929 (95% CI, 0.0352 to 0.24512) for failure to document. Only 1 individual returned to the ED for recurrent symptoms and was discharged during the study period.  

Investigators concluded that at a tertiary care center, patients with ACEI-induced angioedema experiencing mild symptoms could be safely discharged from the ED with a low risk of early readmission, while those with severe symptoms, such as airway compromise, required admission with subsequent safe discharge and no documented early readmission. 

Source: intjem.biomedcentral.com/articles/10.1186/s12245-024-00772-5