title: Anaphylaxis in the community setting: determining risk factors for admission.
abstract: BACKGROUND
  Although the identification and management of anaphylaxis in an emergency department setting has been well studied, our understanding of the risk factors for admission in a community-based hospital is lacking.
  
  
  OBJECTIVE
  To determine the demographics and the predictors of hospitalization, in patients presenting with anaphylaxis to a community-based emergency department (ED).
  
  
  METHODS
  We performed a five-year retrospective chart review of all patients seen in the ED of Winthrop University Hospital, a community-based institution, with an International Classification of Diseases, 9(th)Edition code related to anaphylaxis.
  
  
  RESULTS
  Fifty-eight visits met inclusion criteria, of which 34% resulted in hospital admission (95% CI: 22-48%). Univariate predictors for admission included (1) the involvement of 2, 3, and 4 organ systems (26%, 55%, and 75%, respectively; P < .02); (2) gastrointestinal symptoms vs no symptoms (59% vs 24%, P < .02); (3) non-sting (ingested and other allergens) vs insect sting allergen (50% vs 12.5%, P < .005); and (4) a history of an ED visit for anaphylaxis vs none (67% vs 30%, P < .05). Multivariate analysis (logistic regression) confirmed non-sting allergens (p < 0.02) and number of organ systems involved (P < .05) as independent predictors of hospitalization.
  
  
  CONCLUSIONS
  In our study population, the involvement of multiple organ systems, particularly gastrointestinal involvement, a history of ED visits for anaphylaxis, and involvement of ingested or other allergens (non-sting) demonstrated higher admission rates.
authors: Department of Medicine, Winthrop-University Hospital, Mineola, New York 11501, USA.
authors: Ryan
authors: R
authors: Steele
authors: Marie
authors: M
authors: Camacho-Halili
authors: Barry
authors: B
authors: Rosenthal
authors: Mark
authors: M
authors: Davis-Lorton
authors: Marcella
authors: M
authors: Aquino
authors: Luz
authors: L
authors: Fonacier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000485:Allergens / Q000009:adverse effects / Q000276:immunology; D000707:Anaphylaxis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D055815:Young Adult
chemical_list: D000485:Allergens