Concordance with Recommended Postdischarge Care Guidelines among Children with Food-Induced Anaphylaxis

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• 作者：Pamela B. Landsman-Blumberg ; DrPH¹ ; Wenhui Wei ; PhD² ; Damon Douglas ; PharmD³ ; David M. Smith ; PhD¹ ; Sunday Clark ; MPH ; ScD⁴ ; Carlos A. Camargo Jr. ; MD ; DrPH⁵ ; ⁶ ; ^{ccamargo@partners.org" class="auth_mail}
• 关键词：EAI ; Epinephrine autoinjector ; ED ; Emergency department ; ICD-9-CM ; International Classification of Diseases ; Ninth Revision ; Clinical Modification
• 刊名：The Journal of Pediatrics
• 出版年：June 2014
• 年：2014
• 卷：164
• 期：6
• 页码：1444-1448.e1
• 全文大小：325 K

文摘

To describe patient characteristics, concordance with recommended postdischarge care, and risk of repeat events within a cohort of children discharged from an emergency department (ED) or hospital for food-induced anaphylaxis in the US.

Study design

Children (aged <18 years) with an ED visit/hospitalization for food-induced anaphylaxis were identified from the 2002-2008 Truven Health MarketScan databases using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. The initial identified ED visit/hospitalization was the index event. Claims data for the children with continuous medical and prescription coverage for ≥1 year before and after the index event were evaluated. Analyses included the rates of 1-year postdischarge epinephrine autoinjector (EAI) prescription fills, allergist/immunologist visits, and repeat events.

Results

The study cohort comprised 1009 patients with an average age of 7 years, including 58% males, 27% with a history of asthma, and 90% discharged from an ED. Within 1 year postdischarge, 83% had an EAI prescription fill (69% within 1 week postdischarge), 43% had a specialist visit (51% within 4 weeks postdischarge), and 6.4% had evidence of another anaphylaxis-related ED visit/hospitalization.

Conclusion

Among children with food-induced anaphylaxis, within 1 year postdischarge from the ED or hospital, concordance was higher for EAI prescription fills than for allergist/immunologist visits. Subsequent ED visits/hospital stays for anaphylactic events were low. More research is needed to identify barriers between recommendations and physician/patient behaviors, as well as the impact of not following the recommendations on patient outcomes and healthcare costs.