Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Ann Allergy Asthma Immunol. 2012 Mar;108(3):167-71. doi: 10.1016/j.anai.2012.01.012.
Contrast-media (CM) hypersensitivity is a well-known adverse drug reaction. Surveillance of adverse drug reactions usually depends on spontaneous reports. However, the rate of spontaneous reports is low. Recent progress in information technology enables the electronic search on signals of adverse drug reactions from electronic medical recording (EMR) systems.
To analyze the incidence and clinical characteristics of CM hypersensitivity using an EMR-based surveillance system.
The surveillance system used signals from standardized terms within the international classification of nursing practice terms that can indicate symptoms of CM hypersensitivity and from the order codes for procedures that used contrast media, antihistamine, and epinephrine. The search strategy was validated by allergists comparing the electronic search strategy versus manually reviewing medical charts over one month. The main study covered for one year period.
Detection rate of the electronic search method was 0.9% (7/759), while that of the manual search method was 0.8% (6/759). EMR-based electronic search method was highly efficient: reduced the charts that needed to be reviewed by 96% (28/759). The sensitivity of electronic screening was 66.7%, specificity was 99.6%, and the negative predictive value was 99.7%. CM hypersensitivity reactions were noted in 266 among 12,483 cases (2.1%). Urticaria was the most frequent symptom (74.4%). CT was the most frequent procedure (3.6%) that induced CM hypersensitivity.
A surveillance system using EMR may be a useful tool in the study of drug hypersensitivity epidemiology and may be used in an adverse drug reaction alarm system and as a clinical, decision making support system.
对比剂（CM）过敏是一种已知的药物不良反应。药物不良反应监测通常依赖于自发报告。然而，自发报告的比例很低。信息技术的最新进展使得能够从电子病历（EMR）系统中搜索药物不良反应信号。
使用基于 EMR 的监测系统分析 CM 过敏的发生率和临床特征。
监测系统使用国际护理实践分类标准内的标准化术语的信号，这些术语可以表明 CM 过敏的症状，以及使用对比剂、抗组胺药和肾上腺素的程序的订单代码。过敏症专家通过比较一个月内电子搜索策略与手动审查病历，验证了电子搜索策略。主要研究涵盖一年的时间。
电子搜索方法的检出率为 0.9%（7/759），而手动搜索方法的检出率为 0.8%（6/759）。基于 EMR 的电子搜索方法非常高效：将需要审查的图表减少了 96%（28/759）。电子筛选的灵敏度为 66.7%，特异性为 99.6%，阴性预测值为 99.7%。在 12483 例病例中，有 266 例（2.1%）出现 CM 过敏反应。荨麻疹是最常见的症状（74.4%）。CT 是最常见的引起 CM 过敏的程序（3.6%）。
使用 EMR 的监测系统可能是研究药物过敏反应流行病学的有用工具，可用于药物不良反应报警系统和作为临床决策支持系统。
