Paediatric Allergy, Immunology and Infectious Diseases, Southampton University Hospitals NHS Trust, Southampton, UK.
Drug Saf. 2010 Jan 1;33(1):57-64. doi: 10.2165/11318970-000000000-00000.
Anaphylaxis is a clinical diagnosis with no gold-standard test. Recent case definitions have attempted to provide objective criteria for diagnosis. The aim of this study was to compare the diagnostic concordance of the Brighton Collaboration case definition (the 'Brighton' case definition) to the consensus case definition from the Second Symposium on the Definition and Management of Anaphylaxis (the 'Symposium' definition). The study setting was a hospital-based emergency department in the UK. We identified cases of anaphylaxis by physicians' discharge diagnoses over a 2-year period from 2005 to 2006, and used randomly selected cases of allergic reaction, asthma and urticaria as a control group. Data was extracted by clinicians (who were unaware of the content of either case definition), and the two case definitions were applied by Boolean operators in a Microsoft Excel spreadsheet. Concordance between the case definitions was measured using Cohen's kappa (kappa) statistic. We reviewed 128 sets of notes, with 47 cases of anaphylaxis. Brighton and Symposium definitions had sensitivities of 0.681 and 0.671, respectively, and specificities of 0.790 and 0.704, respectively. A discordant result was found in 36/128 cases (28.1%; kappa = 0.414 [95% CI 0.253, 0.574]), which represents a moderate level of agreement between case definitions. The Brighton case definition has a similar diagnostic concordance to the Symposium case definition. It does not seem to over- or underestimate cases and is sufficiently unique that the identification of an allergic trigger does not have to form part of the case definition. This will be important in the recognition of anaphylaxis resulting from the administration of drug and vaccines, where causality should be examined separately from case ascertainment.
过敏反应是一种临床诊断，没有金标准测试。最近的病例定义试图为诊断提供客观标准。本研究的目的是比较布莱顿合作组织病例定义（“布莱顿”病例定义）与过敏反应第二次专题研讨会定义的共识病例定义（“研讨会”定义）的诊断一致性。研究地点是英国的一家医院急诊科。我们通过 2005 年至 2006 年期间医生的出院诊断确定过敏反应病例，并将随机选择的过敏反应、哮喘和荨麻疹病例作为对照组。数据由临床医生提取（他们不知道任何病例定义的内容），并在 Microsoft Excel 电子表格中使用布尔运算符应用两个病例定义。使用 Cohen's kappa（kappa）统计量衡量病例定义之间的一致性。我们共审查了 128 套病历，其中有 47 例过敏反应。布莱顿和研讨会的定义的敏感性分别为 0.681 和 0.671，特异性分别为 0.790 和 0.704。在 128 例中，有 36 例结果不一致（28.1%；kappa=0.414 [95%CI 0.253, 0.574]），这表明两个病例定义之间存在中等程度的一致性。布莱顿病例定义与研讨会病例定义具有相似的诊断一致性。它似乎不会过高或过低估计病例，并且足够独特，以至于识别过敏触发因素不必成为病例定义的一部分。这在识别因药物和疫苗给药引起的过敏反应时非常重要，在这种情况下，因果关系应与病例确定分开进行检查。
