Inpatient consultation of allergy/immunology in a tertiary care setting.
BACKGROUND
Few studies examine the referral patterns for allergy/immunology (A/I) inpatient consultation.


OBJECTIVE
The purpose of this study was to examine the primary reason and trends for A/I inpatient consultation to improve fellowship training.


METHODS
We performed a retrospective chart review of all inpatient A/I consults from July 1, 1987 to June 30, 2001 to determine the primary reason for consultation. We also reviewed trends in the total admissions and the average daily patient load compared with A/I consultation.


RESULTS
A total of 1,284 A/I inpatient consults were reviewed. Thirty-six percent (460 of 1,284) of inpatient consults were for evaluation of adverse drug reactions, 21% (270 of 1,284) asthma, 21% (272 of 1,284) miscellaneous reasons, 8% (109 of 1,284) possible immunodeficiency, 7% (93 of 1,284) angioedema/urticaria, and 6% (80 of 1,284) anaphylaxis. Our results demonstrated a fall in inpatient consults that correlated with a similar fall in total hospital admissions. The ratio of A/I inpatient consults to total admissions remained constant. Additionally, the ratio of A/I consults to average daily patient load increased over the study period. There was a decrease in asthma and adverse drug reaction consults, whereas immunodeficiency and anaphylaxis referrals remained stable.


CONCLUSIONS
Identifying the most common reasons for inpatient consultation provides a guide for the education of A/I fellows and primary care residents. Inpatient consultation continues to play a crucial role in A/I training as it provides unique opportunities to evaluate serious life threatening diseases. An unchanged trend of consultation for immunodeficiency and anaphylaxis reaffirms the importance of the allergist/immunologist as a valuable resource for inpatient consultation.
Department of Allergy/Immunology, Wilford Hall Medical Center, Lackland AFB, Texas 78236-5300, USA. Ronald.England@lackland.af.mil
Ronald W
RW
England
Thomas C
TC
Ho
Diane C
DC
Napoli
James M
JM
Quinn
D000293:Adolescent; D000328:Adult; D000368:Aged; D000486:Allergy and Immunology / Q000706:statistics & numerical data*; D000707:Anaphylaxis / Q000453:epidemiology; D000799:Angioedema / Q000453:epidemiology; D001249:Asthma / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003953:Diagnosis-Related Groups; D004342:Drug Hypersensitivity / Q000453:epidemiology; D005260:Female; D006772:Hospitals, Military / Q000706:statistics & numerical data*; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000453:epidemiology; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology