Predictors of Acute Care Reutilization in Pediatric Patients With Amoxicillin-Associated Reactions
Susan S Xie1, Katharine M Guarnieri1, Joshua D Courter2
1Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Amoxicillin-associated reactions (AARs) in children often lead to emergency care reuse. Key predictors for reuse include specific symptoms like fever and urticaria, and lack of documented return precautions for young children.
Area of Science:
- Pediatric Emergency Medicine
- Allergy and Immunology
- Clinical Informatics
Background:
- Amoxicillin-associated reactions (AARs) account for significant healthcare utilization.
- Approximately 10% of pediatric patients with AARs revisit emergency departments (ED) or urgent care (UC) settings.
Purpose of the Study:
- Identify predictors of ED/UC reutilization in pediatric patients with AARs.
- Examine clinical features and management strategies associated with AAR reutilization.
Main Methods:
- Retrospective chart review of 668 pediatric patients with AARs over two years.
- Analysis of clinical features (rash phenotype, systemic symptoms) and provider management.
- Statistical modeling to predict ED/UC reutilization.
Main Results:
- Male sex, fever, angioedema, joint involvement, and gastrointestinal symptoms were associated with higher reutilization rates.
- Urticaria was a more frequent rash phenotype in patients who reused ED/UC services.
- Younger children (<2 years) were more likely to reutilize care if return precautions were not documented.
Conclusions:
- Clinical features and management gaps can inform interventions to optimize care for pediatric AARs.
- Improved anticipatory guidance and early allergy consultation may reduce ED/UC reutilization.
- Further prospective studies are needed to validate interventions and assess allergy testing impact.
Background:
Amoxicillin-associated reactions (AARs) contribute to substantial health care utilization, with a reutilization rate of 10% in pediatric emergency department (ED) and urgent care (UC) settings.
Objective:
To identify predictors of ED/UC reutilization by examining patients' clinical features and providers' management of AARs.
Methods:
Through a retrospective chart review of 668 patients presenting with AARs over 2 years to the pediatric ED/UC, we examined clinical features associated with ED/UC reutilization, including rash phenotype, systemic symptoms (fever, angioedema, joint involvement, gastrointestinal symptoms), and providers' management (pharmacologic treatment and counseling). We then constructed a statistical model to predict ED/UC reutilization using stepwise backward model selection.
Results:
ED/UC reutilizers were more likely to be male (P = .008) and have fever (P = .0001), angioedema (P < .0001), joint involvement (P < .0001), and gastrointestinal symptoms (P = .0001) during their AAR course. Rash phenotypes differed between groups (P < .0001), as ED/UC reutilizers more frequently exhibited urticaria. However, there were no differences in clinical management between groups, including pharmacologic recommendations, at the initial ED/UC encounter. In addition, our statistical model identified younger patients <2 years of age as more likely to reutilize ED/UC resources if providers did not document specific return precautions (odds ratio, 3.6; 95% confidence interval, 1.7-7.7).
Conclusion:
Recognition of clinical features and treatment gaps associated with ED/UC reutilization will guide interventions to optimize care in children presenting with AARs, such as improved anticipatory guidance and early allergy consultation. Prospective studies are needed to determine whether these interventions will reduce ED/UC reutilization and facilitate timely allergy testing.
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