Prediction Model for Children With Anaphylaxis Who May Not Require Emergency Department Care: A Multicenter...

Area of Science:

• Pediatric Emergency Medicine
• Allergy and Immunology
• Clinical Informatics

Background:

• The 2023 US Anaphylaxis Practice Parameter suggests some patients receiving epinephrine in the community may avoid emergency department (ED) visits, but criteria and safety are unproven.
• Identifying children who can safely avoid ED visits after prehospital epinephrine administration is crucial for optimizing healthcare resource allocation and patient management.

Purpose of the Study:

• To develop and validate a clinical prediction model to identify children at risk of receiving epinephrine after arriving at the ED.
• This model aims to differentiate between pediatric patients who require additional epinephrine in the ED and those who may not need further treatment.

Main Methods:

• A retrospective cohort study involving 31 centers analyzed children aged 6 months to 18 years who received one pre-ED dose of epinephrine for allergic reactions (2016-2019).
• LASSO regression was used to derive a predictive model from pre-ED factors in 70% of the cohort, with internal (20%) and external (10%) validation.
• The primary outcome was the receipt of epinephrine after ED arrival.

Main Results:

• Of 2318 eligible children, 15.7% received epinephrine post-ED arrival. Key predictors included asthma history, cardiovascular symptoms pre-epinephrine, persistent symptoms, and new/recurrent respiratory, cardiovascular, gastrointestinal, or non-specific symptoms post-epinephrine.
• The model demonstrated a high sensitivity (0.93) and negative predictive value (0.95) for identifying patients who received epinephrine after ED arrival.
• In external validation, 30% of encounters were classified as low risk, indicating potential for ED visit avoidance.

Conclusions:

• A validated clinical prediction model can identify children treated with a single prehospital epinephrine dose who may not require ED care.
• Implementation of this model holds the potential to decrease avoidable ED visits for pediatric anaphylaxis.
• Further research and prospective validation are warranted to integrate this tool into clinical practice for managing anaphylaxis in children.