Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand.
Br J Anaesth. 2019 Jul;123(1):e29-e37. doi: 10.1016/j.bja.2019.02.029. Epub 2019 Apr 24.
Grading schemes for severity of suspected allergic reactions have been applied to the perioperative setting, but there is no scoring system that estimates the likelihood that the reaction is an immediate hypersensitivity reaction. Such a score would be useful in evaluating current and proposed tests for the diagnosis of suspected perioperative immediate hypersensitivity reactions and culprit agents.
We conducted a Delphi consensus process involving a panel of 25 international multidisciplinary experts in suspected perioperative allergy. Items were ranked according to appropriateness (on a scale of 1-9) and consensus, which informed development of a clinical scoring system. The scoring system was assessed by comparing scores generated for a series of clinical scenarios against ratings of panel members. Supplementary scores for mast cell tryptase were generated.
Two rounds of the Delphi process achieved stopping criteria for all statements. From an initial 60 statements, 43 were rated appropriate (median score 7 or more) and met agreement criteria (disagreement index <0.5); these were used in the clinical scoring system. The rating of clinical scenarios supported the validity of the scoring system. Although there was variability in the interpretation of changes in mast cell tryptase by the panel, we were able to include supplementary scores for mast cell tryptase.
We used a robust consensus development process to devise a clinical scoring system for suspected perioperative immediate hypersensitivity reactions. This will enable objectivity and uniformity in the assessment of the sensitivity of diagnostic tests.
严重程度分级方案已被应用于疑似过敏反应的围手术期，但目前还没有估计反应是否为速发型过敏反应的评分系统。这样的评分系统将有助于评估目前和拟议的用于诊断疑似围手术期速发型过敏反应和罪魁祸首的检测方法。
我们进行了一项涉及 25 名国际多学科疑似围术期过敏专家的 Delphi 共识过程。根据适宜性（1-9 分）和一致性对项目进行排序，这为临床评分系统的制定提供了信息。通过比较一系列临床情况的评分与小组成员的评分，评估了评分系统。还生成了肥大细胞类胰蛋白酶的补充评分。
两轮 Delphi 过程均达到了所有声明的停止标准。从最初的 60 个陈述中，有 43 个被评为适宜（中位数评分为 7 或更高）并符合一致性标准（分歧指数<0.5）；这些都被用于临床评分系统。对临床情况的评分支持了评分系统的有效性。尽管小组成员对肥大细胞类胰蛋白酶的变化有不同的解释，但我们仍能够为肥大细胞类胰蛋白酶补充评分。
我们使用了一种稳健的共识制定过程来设计疑似围手术期速发型过敏反应的临床评分系统。这将使诊断测试的敏感性评估具有客观性和一致性。
