Urticaria in a family practice

A review of the charts of 79 patients with urticaria was conducted in a residency-based family practice center. All patients seen with urticaria in 7 years who were identified by the practice-data retrieval system were included in the review. The annual incidence of urticaria was 0.27 percent. Female patients predominated (76 percent), and 70 percent of the cases lasted less than 6 weeks. A personal history of atopy was more common in acute urticaria than in urticaria lasting longer than 6 weeks (P less than .05). No causes were identified in 54 percent of the cases. Association with zomepirac and symptomatic dermographism were each noted in three cases. Diagnostic tests were performed in 17 percent of cases, and consultation or referral occurred in 15 percent. Treatment usually included antihistamines (89 percent). The coded diagnosis was judged by the chart reviewers to be incorrect or inadequately supported in 28 of the 108 charts (26 percent) coded urticaria. In 25 charts coded for other skin disorders, three cases (12 percent) of urticaria were noted by the chart reviewers. Coding errors involving digit transposition were noted in three of 1,044 cases. Diagnostic error, incorrect coding by nonphysicians or by physicians not familiar with the coding system, or even clerical error may be a significant problem in this type of study.