NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
Massachusetts General Hospital, Boston, Massachusetts.
Ann Allergy Asthma Immunol. 2018 Apr;120(4):419-423. doi: 10.1016/j.anai.2018.01.029.
Changes in emergency department (ED) concordance with guidelines for the management of stinging insect-induced anaphylaxis (SIIA) are not known.
To describe temporal changes in ED concordance with guidelines for the management of SIIAs.
We analyzed data from 2 multicenter retrospective studies of patients with stinging insect-related acute allergic reactions seen in 1 of 14 North American EDs during 2 periods: 1999 through 2001 and 2013 through 2015. Visits were identified similarly across studies (eg, using International Classification of Diseases, Ninth Revision, Clinical Modification codes 989.5, 995.0, and 995.3). Anaphylaxis was defined as an acute allergic reaction with involvement of at least 2 organ systems or hypotension. We compared concordance between periods with 4 guideline recommendations: (1) treatment with epinephrine, (2) discharge prescription for epinephrine auto-injector, (3) referral to an allergist/immunologist, and (4) instructions to avoid the offending allergen.
We compared 182 patients with SIIA during 1999 to 2001 with 204 during 2013 to 2015. Any treatment with epinephrine (before arrival to the ED or in the ED) increased over time (30% vs 49%; P < .001). Prescriptions for epinephrine auto-injector at discharge increased significantly (34% vs 57%; P < .001), whereas documentation of referral to an allergist/immunologist decreased (28% vs 12%; P = .002), and instructions to avoid the offending allergen did not change (23% vs 24%; P = .94). Receipt of at least 3 guideline recommendations increased over time; however, the comparison was not statistically significant (10% vs 16%; P = .15).
During the nearly 15-year study interval, we observed increased ED concordance with epinephrine-related guideline recommendations for the management of SIIA. Reasons for the decrease in allergy/immunology referrals merit further study.
急诊科（ED）对蜂蜇伤后过敏反应（SIIA）管理指南的遵循情况发生了变化。
描述 ED 对 SIIA 管理指南的遵循情况随时间的变化。
我们分析了 2 项多中心回顾性研究的数据，这些研究纳入了 14 家北美 ED 中在 2 个时期内发生的与蜂蜇伤相关的急性过敏反应患者：1999 年至 2001 年和 2013 年至 2015 年。研究中使用了相同的检索方法（例如，使用国际疾病分类，第 9 修订版，临床修正版代码 989.5、995.0 和 995.3）。过敏反应被定义为涉及至少 2 个器官系统的急性过敏反应或低血压。我们比较了两个时期的 4 条指南建议的一致性：（1）使用肾上腺素治疗，（2）开具肾上腺素自动注射器的出院处方，（3）转介给过敏症/免疫学家，以及（4）指导避免接触过敏原。
我们比较了 1999 年至 2001 年的 182 例 SIIA 患者与 2013 年至 2015 年的 204 例患者。任何在急诊科之前或急诊科内接受肾上腺素治疗（ED）的患者数量随时间增加（30%比 49%；P<0.001）。出院时开具肾上腺素自动注射器的处方显著增加（34%比 57%；P<0.001），而转介给过敏症/免疫学家的比例下降（28%比 12%；P=0.002），避免接触过敏原的指导没有变化（23%比 24%；P=0.94）。至少接受 3 项指南建议的患者数量随时间增加；然而，比较没有统计学意义（10%比 16%；P=0.15）。
在近 15 年的研究期间，我们观察到 ED 对 SIIA 管理指南中与肾上腺素相关的建议的遵循情况有所增加。过敏/免疫学转介减少的原因值得进一步研究。
