Division of Emergency Medicine, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America.
Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2019 Feb 7;14(2):e0211949. doi: 10.1371/journal.pone.0211949. eCollection 2019.
Opportunity exists to reduce unnecessary hospitalizations for children with anaphylaxis given wide variation in admission rates across U.S. emergency departments (EDs). We sought to identify children hospitalized with anaphylaxis at low risk of receiving epinephrine and other acute inpatient therapies, as these patients may be candidates for ED discharge rather than inpatient hospitalization.
We conducted a single-center retrospective cohort study of children 1-21 years of age hospitalized with anaphylaxis from 2009 to 2016. Acute inpatient therapies included intramuscular (IM) or racemic epinephrine, bronchodilators, fluid boluses, vasopressors, non-invasive ventilation, or intubation. We derived age-specific (pre-verbal [<36 months] vs. verbal [≥ 36 months]) prediction rules using recursive partitioning to identify children at low risk of receiving acute inpatient therapies.
During the study period 665 children were hospitalized for anaphylaxis, of whom 108 (16.2%) received acute inpatient therapies. The prediction rule for patients < 36 months (no wheezing, no cardiac involvement [hypotension or wide pulse pressure]) had a sensitivity of 90.5% (CI 69.6-98.8%) and a negative predictive value of 98.3% (CI 94.1-99.8%) for identifying children at low risk of receipt of acute inpatient therapies during hospitalization. For children ≥ 36 months, the prediction rule (no wheezing, no cardiac involvement, presence of gastrointestinal symptoms) had a sensitivity of 90.8% (CI 82.7-96.0%) and a negative predictive value of 92.4% (CI 85.6-96.7%).
We derived age specific prediction rules for children hospitalized with anaphylaxis at low risk of receiving epinephrine and other acute inpatient therapies. These children may be candidates for ED discharge rather than inpatient hospitalization.
鉴于美国各地急诊部（ED）的住院率存在广泛差异，有机会减少因过敏反应而住院的儿童的不必要住院。我们试图确定因过敏反应住院且接受肾上腺素和其他急性住院治疗风险较低的儿童，因为这些患者可能是 ED 出院而不是住院治疗的候选者。
我们对 2009 年至 2016 年期间因过敏反应住院的 1-21 岁儿童进行了单中心回顾性队列研究。急性住院治疗包括肌肉内（IM）或消旋肾上腺素、支气管扩张剂、液体冲击、血管加压素、无创通气或插管。我们使用递归分区法得出了特定年龄（无言语[<36 个月]与有言语[≥36 个月]）的预测规则，以确定接受急性住院治疗风险较低的儿童。
在研究期间，有 665 名儿童因过敏反应住院，其中 108 名（16.2%）接受了急性住院治疗。<36 个月患者（无喘息，无心脏受累[低血压或宽脉压]）的预测规则的敏感性为 90.5%（CI 69.6-98.8%），阴性预测值为 98.3%（CI 94.1-99.8%），可识别出在住院期间接受急性住院治疗风险较低的儿童。对于≥36 个月的儿童，预测规则（无喘息，无心脏受累，存在胃肠道症状）的敏感性为 90.8%（CI 82.7-96.0%），阴性预测值为 92.4%（CI 85.6-96.7%）。
我们为因过敏反应住院且接受肾上腺素和其他急性住院治疗风险较低的儿童制定了特定年龄的预测规则。这些儿童可能是 ED 出院而不是住院治疗的候选者。
