title: Concordance with recommended postdischarge care guidelines among children with food-induced anaphylaxis.
abstract: OBJECTIVE
  To describe patient characteristics, concordance with recommended postdischarge care, and risk of repeat events within a cohort of children discharged from an emergency department (ED) or hospital for food-induced anaphylaxis in the US.
  
  
  METHODS
  Children (aged <18 years) with an ED visit/hospitalization for food-induced anaphylaxis were identified from the 2002-2008 Truven Health MarketScan databases using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. The initial identified ED visit/hospitalization was the index event. Claims data for the children with continuous medical and prescription coverage for ≥1 year before and after the index event were evaluated. Analyses included the rates of 1-year postdischarge epinephrine autoinjector (EAI) prescription fills, allergist/immunologist visits, and repeat events.
  
  
  RESULTS
  The study cohort comprised 1009 patients with an average age of 7 years, including 58% males, 27% with a history of asthma, and 90% discharged from an ED. Within 1 year postdischarge, 83% had an EAI prescription fill (69% within 1 week postdischarge), 43% had a specialist visit (51% within 4 weeks postdischarge), and 6.4% had evidence of another anaphylaxis-related ED visit/hospitalization.
  
  
  CONCLUSIONS
  Among children with food-induced anaphylaxis, within 1 year postdischarge from the ED or hospital, concordance was higher for EAI prescription fills than for allergist/immunologist visits. Subsequent ED visits/hospital stays for anaphylactic events were low. More research is needed to identify barriers between recommendations and physician/patient behaviors, as well as the impact of not following the recommendations on patient outcomes and healthcare costs.
authors.affiliation: Truven Health Analytics, Bethesda, MD.
authors.forename: Pamela B
authors.initials: PB
authors.lastname: Landsman-Blumberg
authors.affiliation: Sanofi US, Bridgewater, NJ.
authors.forename: Wenhui
authors.initials: W
authors.lastname: Wei
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Damon
authors.initials: D
authors.lastname: Douglas
authors.affiliation: Truven Health Analytics, Bethesda, MD.
authors.forename: David M
authors.initials: DM
authors.lastname: Smith
authors.affiliation: Department of Emergency Medicine, Weill Cornell Medical College, New York, NY.
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: ccamargo@partners.org.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000592:standards; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005512:Food Hypersensitivity / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017408:Guidelines as Topic; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000592:standards*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D004837:Epinephrine