From the Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Pulmonary, Allergy and Critical Care Medicine, Stanford School of Medicine, Palo Alto, California.
Allergy Asthma Proc. 2021 May 1;42(3):247-256. doi: 10.2500/aap.2021.42.210031.
Allergic reactions, including anaphylaxis, are rising among children. Little is known about health care utilization among infants and toddlers. Our objective was to characterize health care utilization and charges for acute allergic reactions (AAR). We conducted a retrospective cohort study of trends in emergency department (ED) visits and revisits, hospitalizations and rehospitalizations, and charges among infants and toddlers (ages < 3 years), with an index ED visit or hospitalization for AAR (including anaphylaxis). We used data from population-based multipayer data: State Emergency Department Databases and State Inpatient Databases from New York and Nebraska. Multivariable logistic regression was used to identify factors associated with ED revisits and rehospitalizations. Between 2006 and 2015, infant and toddler ED visits for AAR increased from 27.8 per 10,000 population to 35.2 (P < 0.001), whereas hospitalizations for AAR remained stable (P = 0.11). In the one year after an index AAR visit, 5.1% of these patients had at least one AAR ED revisit and 5.9% had at least one AAR rehospitalization. Factors most strongly associated with AAR ED revisits included an index visit hospitalization and receipt of epinephrine. Total charges for AAR ED visits (2009-2015) and hospitalizations (2011-2015) were more than $29 million and $11 million, respectively. Total charges increased more than fourfold for both AAR ED revisits for AAR rehospitalizations during the study period. Infants and toddlers who presented with an AAR were at risk for ED revisits and rehospitalizations for AAR within the following year. The charges associated with these revisits were substantial and seemed to be increasing.
过敏反应（包括过敏反应）在儿童中呈上升趋势。对于婴儿和幼儿的医疗保健利用情况知之甚少。我们的目的是描述急性过敏反应（AAR）的急诊（ED）就诊和复诊、住院和再住院以及费用的利用情况。我们对纽约州和内布拉斯加州基于人群的多付款人数据：州急诊数据库和州住院数据库中的婴儿和幼儿（<3 岁）的 ED 就诊或住院治疗因 AAR（包括过敏反应）的趋势进行了回顾性队列研究。我们使用多变量逻辑回归来确定与 ED 复诊和再住院相关的因素。在 2006 年至 2015 年间，婴儿和幼儿因 AAR 的 ED 就诊量从每 10,000 人 27.8 例增加到 35.2 例（P<0.001），而因 AAR 的住院率保持稳定（P=0.11）。在 AAR 就诊后一年，这些患者中有 5.1%至少有一次 AAR ED 复诊，5.9%至少有一次 AAR 再住院。与 AAR ED 复诊最相关的因素包括索引就诊住院和接受肾上腺素。AAR ED 就诊（2009-2015 年）和住院（2011-2015 年）的总费用超过 2900 万美元和 1100 万美元，分别。在研究期间，AAR ED 复诊和 AAR 再住院的总费用增加了四倍多。在接下来的一年中，患有 AAR 的婴儿和幼儿有 ED 复诊和 AAR 再住院的风险。这些复诊的费用相当可观，而且似乎还在增加。
