Stiles Samantha L, Sanfilippo Frank M, Murray Kevin, Loh Richard, Said Maria, Clifford Rhonda M, Vale Sandra L, Salter Sandra M
School of Allied Health, The University of Western Australia, Perth, Australia.
School of Population and Global Health, The University of Western Australia, Perth, Australia.
J Allergy Clin Immunol Glob. 2024 Nov 13;4(1):100371. doi: 10.1016/j.jacig.2024.100371. eCollection 2025 Feb.
Anaphylaxis is increasing in Australia involving all levels of the health care system. Although guidelines recommend calling an ambulance and 4-hour observation, knowledge gaps exist regarding where people experiencing anaphylaxis receive care.
We sought to examine care pathways for anaphylaxis in Western Australia and factors associated with seeking care from ambulance versus the emergency department (ED), and subsequent hospital admission.
A cross-sectional study was undertaken using linked ambulance, ED, hospital, and mortality data. The proportion of anaphylaxis events following each care pathway from 2010 to 2017 was examined. Multivariable logistic regression was used to determine factors associated with ambulance versus ED as the first point of care, with additional models to determine risk of admission.
Most of the 16,456 anaphylaxis events followed 6 distinct care pathways. ED was first point of care in 9,713 (59.0%) events; ambulance in 5,926 (36.0%); and hospital in 817 (5.0%). Factors associated with ambulance attendance compared with ED were metropolitan region (odds ratio [OR], 3.00; 95% CI, 2.70-3.34), age more than 65 years (OR, 2.98; 95% CI, 2.54-3.50), and anaphylaxis occurring during the day (OR, 1.31; 95% CI, 1.21-1.42). Risk of subsequent hospitalization was associated with food trigger in ED (OR, 1.52; 95% CI, 1.11-2.07), age more than 65 years (OR, 1.48; 95% CI, 1.24-1.77), children younger than 5 years (OR, 1.24; 95% CI, 1.08-1.41), and history of cancer (OR, 1.36; 95% CI, 1.18-1.56).
Most people experiencing anaphylaxis present directly to ED; however, ambulance care is still substantial and around half the events involved observation in the hospital. Discrepancies in recording of anaphylaxis across linked data sets highlight gaps in current burden data, supporting the need for improved reporting.
在澳大利亚，过敏反应呈上升趋势，涉及医疗保健系统的各个层面。尽管指南建议呼叫救护车并进行4小时观察，但对于过敏反应患者接受治疗的地点仍存在知识空白。
我们试图研究西澳大利亚州过敏反应的治疗途径，以及与通过救护车而非急诊科（ED）寻求治疗以及随后住院相关的因素。
采用一项横断面研究，将救护车、急诊科、医院和死亡率数据相联系。研究了2010年至2017年每条治疗途径下过敏反应事件的比例。使用多变量逻辑回归来确定与将救护车与急诊科作为首个治疗点相关的因素，并使用其他模型来确定住院风险。
16456例过敏反应事件中的大多数遵循6种不同的治疗途径。在9713例（59.0%）事件中，急诊科是首个治疗点；在5926例（36.0%）事件中，是救护车；在817例（5.0%）事件中，是医院。与通过急诊科相比，与呼叫救护车相关的因素包括大都市地区（比值比[OR]，3.00；95%置信区间[CI]，2.70 - 3.34）、年龄超过65岁（OR，2.98；95% CI，2.54 - 3.50）以及过敏反应发生在白天（OR，1.31；95% CI，1.21 - 1.42）。后续住院风险与急诊科的食物触发因素（OR，1.52；95% CI，1.11 - 2.07）、年龄超过65岁（OR，1.48；95% CI，1.24 - 1.77）、5岁以下儿童（OR，1.24；95% CI，1.08 - 1.41）以及癌症病史（OR，1.36；95% CI，1.18 - 1.56）相关。
大多数过敏反应患者直接前往急诊科就诊；然而，通过救护车治疗的情况仍然相当多，约一半的事件涉及在医院观察。跨链接数据集的过敏反应记录差异凸显了当前负担数据的空白，支持改进报告的必要性。
