Anaphylaxis risk factors for hospitalization and intensive care: A comparison between adults and children in an upstate New York emergency department

Background:

Anaphylaxis is an acute, systemic allergic reaction that can be life threatening, and with an increasing incidence and costs associated with hospitalization and intensive care.

Objective:

To assess the risk factors for hospitalization by comparing pediatric and adult patients.

Methods:

We performed a retrospective chart review for patients with anaphylactic reactions who presented to the Albany Medical Center emergency department between 2005 and 2012.

Results:

We identified 267 anaphylactic reactions in 258 patients (143 adults). Of those, 128 (48%) were not coded as anaphylaxis despite fulfilling diagnostic criteria. Foods were the most common trigger both in adults and children. Factors associated with increased odds of hospitalization (intensive care unit [ICU] and hospital floor combined) included a severity score of 3 in both children (odds ratio [OR] 41.86 [95% confidence interval {CI}, 2.9‐602.48], p = 0.006) and adults (OR 32.52 [95% CI, 6.28‐168.35], p < 0.001), and those who received multiple doses of epinephrine in children (OR 15.36 [95% CI, 1.9‐121.4], p = 0.009) and adults (OR 11.49 [95% CI, 3.08‐44.13], p < 0.001). Patient characteristics associated with ICU admission in children and adults combined included Medicare and/or Medicaid insurance (OR 4.96 [95% CI, 1.14‐21.67], p = 0.023), cutaneous symptoms (OR 0.19 [95% CI, 0.04‐0.79], p = 0.23), and cardiovascular symptoms (OR 5.8 [95% CI, 1.16‐28.87], p = 0.032).

Conclusion:

Anaphylaxis remains underrecognized and improperly treated in the emergency department. Severity of symptoms and receiving multiple doses of epinephrine were associated with hospitalization in both children and adults. Medicare and/or Medicaid insurance, and cardiovascular or cutaneous symptoms were characteristics associated with ICU admission in our cohort.