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Emergency and Hospital Care for Food-Related Anaphylaxis in Children
Joshua P Parlaman1, Assaf P Oron2, Neil G Uspal2
1Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, 98105-0371, USA.; and joshua.parlaman@seattlechildrens.org.
Insights
The incidence of food-related anaphylaxis in pediatric emergency departments (EDs) is rising, yet hospital admission rates remain stable. Key factors influence admission decisions for pediatric anaphylaxis cases.
Area of Science:
- Pediatric Allergy and Immunology
- Emergency Medicine
- Public Health
Background:
- Food-related anaphylaxis is a significant concern in pediatric healthcare.
- Understanding trends in emergency and hospital care is crucial for effective management.
- Revisit rates provide insight into the adequacy of initial treatment and discharge planning.
Purpose of the Study:
- To describe trends in emergency department (ED) and hospital care for pediatric food-related anaphylaxis.
- To determine the revisit rates for children experiencing food-related anaphylaxis.
- To identify predictors for hospital admission in pediatric food-related anaphylaxis cases.
Main Methods:
- Retrospective cohort study of children aged 6 months to 18 years with food-related anaphylaxis.
- Data collected from 37 children's hospitals between 2007 and 2012.
- Analysis included summary statistics, trend evaluation, multivariable regression for admission predictors, and calculation of revisit rates.
Main Results:
- Food-related anaphylaxis increased from 41 to 72 per 100,000 ED visits.
- Hospital admission rates remained stable, with significant variability (20%-98%).
- Predictors for admission included male sex, age < 1 year, specific food allergens (tree nut), and comorbidities like asthma or chronic complex conditions. The 3-day revisit rate was 3% for ED-discharged patients and 0.6% for admitted patients.
Conclusions:
- The incidence of pediatric food-related anaphylaxis in EDs is increasing.
- Hospital admission rates for food-related anaphylaxis are stable but highly variable.
- Further research is needed to optimize management strategies for this critical condition.
Objectives:
Among patients with food-related anaphylaxis, to describe trends in emergency and hospital care and determine the revisit rate.
Methods:
This retrospective cohort study included children 6 months to 18 years of age with food-related anaphylaxis from 37 children's hospitals between 2007 and 2012. Summary statistics and trends for patient characteristics were evaluated. Multivariable regression was used to identify predictors for hospital admission. Revisit rates to either the emergency department (ED) and/or inpatient unit were calculated.
Results:
7303 patients were evaluated in the ED; 3652 (50%) were admitted to the hospital. Hospital admission rates varied widely (range, 20%-98%). Food-related anaphylaxis increased from 41 per 100 000 ED visits to 72 per 100 000 while hospital admission rates did not change. Males (odds ratio [OR], 1.2 [95% confidence interval (CI), 1.0-1.4]), patients < 1 year old (OR, 1.8 [95% CI, 1.3-2.5]), those with anaphylaxis to either peanut (OR, 1.2 [95% CI, 1.0-1.5]) or tree nut (OR, 1.7 [95% CI, 1.3-2.1]), and patients with asthma (OR, 7.4 [95% CI, 5.8-9.3]) or a chronic complex condition (OR, 5.2 [95% CI, 3.0-9.0]) were more likely to be admitted to the hospital. The 3-day revisit rate was 3% for patients discharged from the ED and 0.6% for those admitted on the index visit.
Conclusions:
The incidence of food-related anaphylaxis in pediatric EDs is increasing, but rates of hospital admission are stable. Hospital admission is common but widely variable. Further research is needed to identify optimal management practices for this potentially life-threatening problem.
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