Development of the Hereditary Angioedema Rapid Triage Tool.

Angioedema Angioedemas, Hereditary / diagnosis Emergency Service, Hospital Humans Retrospective Studies Triage
Delphi study Hereditary angioedema Retrospective study

Journal

The journal of allergy and clinical immunology. In practice
ISSN: 2213-2201
Titre abrégé: J Allergy Clin Immunol Pract
Pays: United States
ID NLM: 101597220

Informations de publication

Date de publication:
01 2020
Historique:
received: 19 12 2018
revised: 01 05 2019
accepted: 29 05 2019
pubmed: 27 6 2019
medline: 15 5 2021
entrez: 26 6 2019
Statut: ppublish

Résumé

Patients with hereditary angioedema (HAE) present to the emergency department (ED), where their symptoms are often incorrectly attributed to common allergic and gastrointestinal conditions, resulting in major delays in diagnosis and treatment. To develop a rapid triage HAE (Hereditary AngioEdema Rapid Triage [HAE-RT]) tool for ED settings. A mixed-methods approach was used in 3 phases: Phase 1: A literature review on the current management of patients with HAE in the ED. Phase 2: A Delphi study with HAE specialists (N = 9) and Patient Advocacy Group Members (N = 3) to reach consensus on the predictor variables (PVs) to be included in the HAE-RT tool. Phase 3: A retrospective chart review to assess the performance of the PVs for HAE. The literature review informed the final list of PVs included in the HAE-RT prototype. Nine experts participated in the Delphi study. Of 8 identified HAE-specific PVs, 3 reached consensus: (1) absence of urticaria, (2) recurrent abdominal pain/swelling, and (3) lack of response to allergic-directed therapy. The retrospective study included 107 patients (N = 66 with HAE; N = 41 non-HAE). Patients with HAE were more likely to have a family history of HAE (71%; P < .0001), previous recurrent angioedema (96%; P < .002), and previous recurrent abdominal pain (77%; P < .0001), and only 6% responded to allergy treatments (P < .0001). The HAE-RT tool had 98% sensitivity and specificity. Expert consensus led to the identification and prioritization of variables that when incorporated into an HAE-RT tool were associated with a high level of sensitivity and specificity when applied to known patients.

Sections du résumé

BACKGROUND
Patients with hereditary angioedema (HAE) present to the emergency department (ED), where their symptoms are often incorrectly attributed to common allergic and gastrointestinal conditions, resulting in major delays in diagnosis and treatment.
OBJECTIVE
To develop a rapid triage HAE (Hereditary AngioEdema Rapid Triage [HAE-RT]) tool for ED settings.
METHODS
A mixed-methods approach was used in 3 phases: Phase 1: A literature review on the current management of patients with HAE in the ED. Phase 2: A Delphi study with HAE specialists (N = 9) and Patient Advocacy Group Members (N = 3) to reach consensus on the predictor variables (PVs) to be included in the HAE-RT tool. Phase 3: A retrospective chart review to assess the performance of the PVs for HAE.
RESULTS
The literature review informed the final list of PVs included in the HAE-RT prototype. Nine experts participated in the Delphi study. Of 8 identified HAE-specific PVs, 3 reached consensus: (1) absence of urticaria, (2) recurrent abdominal pain/swelling, and (3) lack of response to allergic-directed therapy. The retrospective study included 107 patients (N = 66 with HAE; N = 41 non-HAE). Patients with HAE were more likely to have a family history of HAE (71%; P < .0001), previous recurrent angioedema (96%; P < .002), and previous recurrent abdominal pain (77%; P < .0001), and only 6% responded to allergy treatments (P < .0001). The HAE-RT tool had 98% sensitivity and specificity.
CONCLUSIONS
Expert consensus led to the identification and prioritization of variables that when incorporated into an HAE-RT tool were associated with a high level of sensitivity and specificity when applied to known patients.

Identifiants

DOI: 10.1016/j.jaip.2019.05.056 PMID: 31238160
pubmed: 31238160
pii: S2213-2198(19)30562-8
doi: 10.1016/j.jaip.2019.05.056
pii:
doi:

Types de publication

Consensus Development Conference Journal Article Research Support, Non-U.S. Gov't Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

310-317.e3

Informations de copyright

Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Auteurs

Stephen Betschel (S)

Department of Medicine, Division of Clinical Immunology and Allergy, University of Toronto, Toronto, ON, Canada.

Ernie Avilla (E)

Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada. Electronic address: avillae@mcmaster.ca.

Amin Kanani (A)

Department of Medicine, University of British Columbia Division of Allergy and Clinical Immunology, St Paul's Hospital, Vancouver, BC, Canada.

Monika Kastner (M)

North York General Hospital, New York, NY; IHPME, University of Toronto, Toronto, ON, Canada.

Paul Keith (P)

Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada.

Karen Binkley (K)

Department of Medicine, Division of Clinical Immunology and Allergy, University of Toronto, Toronto, ON, Canada.

Gina Lacuesta (G)

Department of Medicine, Dalhousie University, Halifax, NS, Canada.

Rozita Borici-Mazi (R)

Department of Medicine, Division of Allergy & Immunology, Queens University, Kingston, ON, Canada.

Jacquie Badiou (J)

HAE Canada, Ottawa, ON, Canada.

Anne Rowe (A)

HAE Canada, Ottawa, ON, Canada.

William H Yang (WH)

University of Ottawa Medical School & Ottawa Allergy Research Corporation, Ottawa, ON, Canada.

Susan Waserman (S)

Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Maladies du système immunitaire › Hypersensibilité › Hypersensibilité immédiate › Urticaire › Angioedème › Development of the Hereditary Angioedema Rapid...
questionsmedicales.fr › Maladies du système immunitaire › Déficits immunitaires › Maladies d'immunodéficience primaire › Déficits héréditaires en complément › Angio-oedèmes héréditaires › Development of the Hereditary Angioedema Rapid...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration d'établissement de santé › Administration hospitalière › Services hospitaliers › Service hospitalier d'urgences › Development of the Hereditary Angioedema Rapid...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Development of the Hereditary Angioedema Rapid...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Development of the Hereditary Angioedema Rapid...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services des urgences médicales › Triage › Development of the Hereditary Angioedema Rapid...