Journal article
Further Evaluation of Factors That May Predict Biphasic Reactions in Emergency Department Anaphylaxis Patients
The journal of allergy and clinical immunology in practice (Cambridge, MA), Vol.5(5), pp.1295-1301
09/2017
DOI: 10.1016/j.jaip.2017.07.020
PMID: 28888253
Abstract
Anaphylaxis is a systemic allergic reaction that is commonly treated in the emergency department (ED). The risk of a biphasic reaction is the rationale for observation.
To derive a prediction rule to stratify ED anaphylaxis patients at risk of a biphasic reaction.
We conducted an observational study of a cohort of patients presenting to an academic ED with signs and symptoms of anaphylaxis. We collected clinical data on biphasic reactions meeting National Institutes of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network diagnostic criteria. Logistic regression analyses were conducted to identify predictors of biphasic reactions, and odds ratios (ORs) with 95% CIs are reported. The predictive ability of the model features is summarized using the area under a receiver operating characteristics curve, or AUC. Internally validated AUCs were obtained using bootstrap resampling.
We identified 872 anaphylaxis-related visits. Thirty-six (4.1%) visits resulted in biphasic reactions. Multivariable analysis showed that prior anaphylaxis (OR, 2.74; 95% CI, 1.33-5.63), unknown inciting trigger (OR, 2.40; 95% CI, 1.14-4.99), and first epinephrine administration more than 60 minutes after symptom onset (OR, 2.29; 95% CI, 1.09-4.79) were statistically significantly associated with biphasic reactions. The AUC of this model was 0.70 (95% CI, 0.61-0.79), with an internally validated AUC of 0.67 (95% CI, 0.59-0.76). The P value from the goodness-of-fit test was .91.
Our study demonstrated a 4.1% rate of biphasic reactions and found that prior anaphylaxis, unknown inciting trigger, and delayed epinephrine use were risk factors for biphasic reactions.
Details
- Title: Subtitle
- Further Evaluation of Factors That May Predict Biphasic Reactions in Emergency Department Anaphylaxis Patients
- Creators
- Sangil Lee - Roy J. and Lucille A. Carver College of MedicineAlexa Peterson - Nova Southeastern UniversityChristine M. Lohse - Mayo Clinic in FloridaErik P. Hess - Mayo Clinic in FloridaRonna L. Campbell - Mayo Clinic
- Resource Type
- Journal article
- Publication Details
- The journal of allergy and clinical immunology in practice (Cambridge, MA), Vol.5(5), pp.1295-1301
- DOI
- 10.1016/j.jaip.2017.07.020
- PMID
- 28888253
- NLM abbreviation
- J Allergy Clin Immunol Pract
- ISSN
- 2213-2198
- eISSN
- 2213-2201
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 09/2017
- Academic Unit
- Emergency Medicine; Injury Prevention Research Center
- Record Identifier
- 9984296971202771
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