Division of Allergic Diseases, Mayo Clinic, Rochester, Minn.
Department of Emergency Medicine, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minn.
J Allergy Clin Immunol Pract. 2018 May-Jun;6(3):1002-1009.e2. doi: 10.1016/j.jaip.2017.07.041. Epub 2017 Sep 20.
Although the incidence of anaphylaxis appears to be increasing, trends in anaphylaxis-related health care utilization are not well understood.
To better understand the potential increasing health care burden, we analyzed the changes in anaphylaxis-related health care utilization, including emergency department (ED) discharges, observation stays, inpatient admissions, intensive care unit admissions, and endotracheal intubations.
We conducted an observational study examining outcomes of anaphylaxis-related ED visits between January 1, 2005, and December 31, 2014. We analyzed administrative claims data from OptumLabs Data Warehouse, which includes more than 100 million Medicare Advantage and privately insured enrollees in the United States. We studied trends in the proportions of ED-related anaphylaxis visits based on demographic characteristics, triggers, and ED disposition for our study population.
Among 56,212 anaphylaxis-related ED visits during a 10-year period, the proportion of patient observation/inpatient admissions increased by 37.6% (P = .02), from 13.2% of anaphylaxis-related ED visits in 2005 to 18.2% in 2014. The proportion of patients admitted to the intensive care unit increased by 27.4% (P = .001), from 4.5% in 2005 to 5.8% in 2014. Proportions of endotracheal intubation increased by 145.2% (P < .001).
The increasing proportions of observation/inpatient admissions, intensive care unit admissions, and endotracheal intubations suggest an increase in anaphylaxis severity. Enhanced awareness of these trends among patients, practitioners, and the community is necessary to create effective strategies to prevent anaphylaxis and decrease associated adverse consequences.
尽管过敏反应的发病率似乎在上升，但过敏反应相关医疗保健利用的趋势尚不清楚。
为了更好地了解潜在的日益增加的医疗保健负担，我们分析了过敏反应相关医疗保健利用的变化，包括急诊科（ED）出院、观察留观、住院入院、重症监护病房入院和气管插管。
我们进行了一项观察性研究，研究了 2005 年 1 月 1 日至 2014 年 12 月 31 日期间与 ED 就诊相关的过敏反应结局。我们分析了 OptumLabs Data Warehouse 的行政索赔数据，该数据库包括美国超过 1000 万的医疗保险优势和私人保险参保人。我们根据研究人群的人口统计学特征、触发因素和 ED 处置情况，分析了 ED 相关过敏反应就诊比例的趋势。
在 10 年期间的 56212 例与 ED 相关的过敏反应就诊中，患者观察/住院入院的比例增加了 37.6%（P =.02），从 2005 年的过敏反应相关 ED 就诊的 13.2%增加到 2014 年的 18.2%。入住重症监护病房的患者比例增加了 27.4%（P =.001），从 2005 年的 4.5%增加到 2014 年的 5.8%。气管插管的比例增加了 145.2%（P <.001）。
观察/住院入院、重症监护病房入院和气管插管比例的增加表明过敏反应的严重程度有所增加。患者、医生和社区必须提高对这些趋势的认识，以便制定有效的策略来预防过敏反应并减少相关不良后果。
