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J Pediatr. 2014 Jun;164(6):1444-8.e1. doi: 10.1016/j.jpeds.2014.02.022. Epub 2014 Mar 21.

Concordance with recommended postdischarge care guidelines among children with food-induced anaphylaxis.

Author information

1
Truven Health Analytics, Bethesda, MD.
2
Sanofi US, Bridgewater, NJ.
3
Memorial Sloan Kettering Cancer Center, New York, NY.
4
Department of Emergency Medicine, Weill Cornell Medical College, New York, NY.
5
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: ccamargo@partners.org.

Abstract

OBJECTIVE:

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.

PMID:
24661339
DOI:
10.1016/j.jpeds.2014.02.022
[Indexed for MEDLINE]

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