RATIONALE: Children with allergic reactions often present to the emergency department for treatment. We hypothesized that different types of medical providers, Allergy/Immunology (AI) and Emergency Medicine (EM), would vary in their approaches to management of allergic reactions. METHODS: This was a cross-sectional survey study of EM and AI providers in the University of Colorado hospitals and Colorado Asthma and Allergy Society. The survey consisted of 6 case scenarios of allergic reactions, with 4 representing anaphylaxis that resolved by the time of discharge. Following the scenarios, participants were asked questions about preferred initial therapy, adjunctive therapies, monitoring, outpatient prescription medications, and discharge instructions provided. Survey derivation and validation was accomplished by a multidisciplinary team of experts using a modified Delphi process. RESULTS: 194 of 413 (47%) clinicians responded, with 69 pediatric EM, 50 general EM, 49 AI providers; 26 did not complete demographics. For each clinical scenario there was a statistically significant difference in discharging patients with scheduled steroids: AI providers consistently reported fewer prescriptions than EM for scheduled steroids in all cases of resolved anaphylaxis (p values: 0.00000, 0.00018, 0.00012, 0.00274). In addition, AI providers were less likely to provide scheduled antihistamines than EM in half of the cases (p values: 0.00092 and 0.00010). CONCLUSIONS: Though current evidence does not support its use for all cases of anaphylaxis, most EM providers continued to prescribe scheduled steroids and antihistamines after resolution of anaphylaxis. These results support AI involvement in quality improvement practices within the emergency department.
and Barbara Zucker School of Medi. RATIONALE: There is limited information on the impact of anaphylaxis, a potentially life threatening allergic reaction, in the elderly. This study explores the factors that contribute to under recognition of anaphylaxis in this age group. METHODS: A retrospective analysis of hospitalized patients aged ≥65 years in NY from 2000-2010 was conducted using the Statewide Planning and Research Cooperative System (SPARCS), a statewide administrative database. Cases were identified using anaphylaxis ICD-9 codes or an ICD-9-based diagnostic algorithm incorporating the National Institutes of Allergy and Infectious Disease (NIAID) diagnostic criteria. Cases identified by the algorithm method likely represent missed cases of anaphylaxis. Multinomial regression analysis was used to model selected variables associated with ascertainment method. RESULTS: Of the 3,673 hospitalizations analyzed, anaphylaxis ICD-9 codes identified 1790 (48.7%) cases, the algorithms identified 1701 (46.3.%) and 182 (5.0%) were identified by both. Age ≥85 and 75-84 were 2.4 (95% confidence interval 1.92-2.90) and 1.4 (95% CI 1.25-1.69) times more likely to be in the Algorithm group, respectively. Males were 1.2 times more likely to be included in the Algorithm group (95% CI 1.06-1.41). African Americans, other race and unknown were 1.8 (95% CI 1.52-2.24), 1.4 (95% CI 1.09-1.79) and 1.6 (95% CI 1.10-2.44), times more likely, respectively, to be included in the Algorithm group. Asians were 0.6 times less likely to be included in the Algorithm group (95% CI 0.39-0.98). CONCLUSIONS: Being of older age, male and of minority race were associated with increased likelihood of having unrecognized inpatient anaphylaxis.
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