Pruitt Zachary, Pruitt Rebecca Copeland
Pediatr Emerg Care. 2017 Dec;33(12):e152-e159. doi: 10.1097/PEC.0000000000000794.
Food allergies (FAs) occur in 4% to 8% of children in the United States, and emergency department (ED) visits account for up to 20% of their costs. In 2010, the National Institute of Allergy and Infectious Diseases established diagnostic criteria and management practices for FAs, and recognition and treatment of FAs for pediatric ED practitioners has been described.
This study identified trends and factors related to ED visits for pediatric FAs in the United States from 2001 to 2010. It was hypothesized that FAs increased and that differences existed in ED utilization based on age, insurance status, and geography. Low concordance with treatment guidelines for FAs was expected.
Multivariate logistic regression, using National Hospital Ambulatory Medical Care Survey data, estimated factors associated with ED visits and treatment of FAs and nonspecific allergic reactions. Trends and treatment patters used weighted frequencies to account for the complex 4-stage probability survey design.
An estimated 239,303 (95% confidence interval [CI], 180,322-298,284) children visited the ED for FAs, demonstrating a significant rate increase during the period (53.08, P < 0.001). Logistic regression showed that the odds of ED visits for FAs were significantly associated with Medicaid/State Children's Health Insurance Program insurance (OR, 1.65 [95% CI, 1.01-2.69], P = 0.04), adolescents (OR, 1.92 [95% CI, 1.10-3.35], P = 0.02), and boys (OR, 1.55 [95% CI, 1.03-2.35], P = 0.04). Treatment with epinephrine for anaphylaxis diagnoses occurred in 57.4% of visits (95% CI, 42.3%-66.8%).
Medicaid/State Children's Health Insurance Program-insured pediatric patients had higher odds of visiting ED for recognized FAs and nonspecific allergic reactions and higher odds of receiving epinephrine than privately insured children.
在美国，4%至8%的儿童患有食物过敏（FA），而急诊科（ED）就诊费用占其总费用的比例高达20%。2010年，美国国立过敏与传染病研究所制定了FA的诊断标准和管理规范，并且描述了儿科急诊科医生对FA的识别与治疗方法。
本研究确定了2001年至2010年美国儿科FA患者急诊科就诊的趋势及相关因素。研究假设FA的发病率上升，且基于年龄、保险状况和地理位置，急诊科的利用率存在差异。预计与FA治疗指南的一致性较低。
利用国家医院门诊医疗调查数据进行多因素逻辑回归分析，估计与FA及非特异性过敏反应的急诊科就诊和治疗相关的因素。趋势和治疗模式采用加权频率来考虑复杂的四阶段概率调查设计。
估计有239,303名（95%置信区间[CI]，180,322 - 298,284）儿童因FA到急诊科就诊，在此期间就诊率显著上升（53.08，P < 0.001）。逻辑回归显示，FA患者急诊科就诊的几率与医疗补助/州儿童健康保险计划保险显著相关（比值比[OR]，1.65 [95% CI，1.01 - 2.69]，P = 0.04）、青少年（OR，1.92 [95% CI，1.10 - 3.35]，P = 0.02）以及男孩（OR，1.55 [95% CI，1.03 - 2.35]，P = 0.04）。57.4%的就诊病例（95% CI，42.3% - 66.8%）因过敏反应诊断使用了肾上腺素进行治疗。
与私人保险儿童相比，参加医疗补助/州儿童健康保险计划的儿科患者因确诊的FA和非特异性过敏反应到急诊科就诊的几率更高，接受肾上腺素治疗的几率也更高。
