Predictors of epinephrine dispensing and allergy follow-up after emergency department visit for anaphylaxis

Publication date: Available online 12 September 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Megan Motosue, M. Fernanda Bellolio, Holly K. Van Houten, Nilay D. Shah, Ronna L. Campbell
BackgroundNational guidelines recommend that patients with anaphylaxis be prescribed an epinephrine auto-injector (EAI) and referred to an allergy/immunology (A/I) specialist.ObjectiveTo evaluate guideline concordance and identify predictors of EAI dispensing and A/I follow-up in patients with anaphylaxis treated in the emergency department (ED).MethodsWe identified patients seen in the ED for anaphylaxis from 2010 through 2014 from an administrative claims database using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm.ResultsOf 7,790 patients identified, 46.5% had an EAI dispensed and 28.8% had A/I follow-up within 1 year after discharge. On multivariable analysis, those 65 years or older (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.30–0.41) and with a medication trigger (OR 0.24, 95% CI 0.21–0.28) had a lower likelihood of EAI dispensing. Those younger than 5 years (OR 2.67, 95% CI 2.15–3.32) and with food (OR 1.40, 95% CI 1.24–1.59) or venom (OR 4.48, 95% CI 3.51–5.72) triggers had a higher likelihood of EAI dispensing. Similarly, for A/I follow-up, the likelihood was lower for age 65 years or older (OR 0.46, 95% CI 0.39–0.54) and medication trigger (OR 0.66, 95% CI 0.56–0.78) and higher for age younger than 5 years (OR 3.15, 95% CI 2.63–3.77) and food trigger (OR 1.39, 95% CI 1.22–1.58).ConclusionOverall, 46.5% of patients with anaphylaxis in the ED had EAI dispensing and 28.8% had A/I follow-up. Patient age and triggers were associated with likelihood of EAI dispensing and A/I follow-up. Post-ED visit anaphylaxis management can be improved, with the potential to decrease future morbidity and mortality risk.



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