Multicenter study of emergency department visits for insect sting allergies
ABSTRACT An earlier study of food-related anaphylaxis in the emergency department (ED) suggested low concordance with national guidelines for anaphylaxis management.
To extend these findings, we performed a chart review study to describe current ED management of insect sting allergy.
The Multicenter Airway Research Collaboration performed a chart review study in 15 North American EDs. Investigators reviewed 617 charts of patients with insect sting allergy. Patients were identified by using International Classification of Diseases, 9th Revision, codes 989.5 (toxic effect of venom), 995.0 (other anaphylactic shock), and 995.3 (allergy, unspecified).
The cohort was 42% female and 61% white, with a mean age of 36+/-19 years. In this cohort, 58% had local reactions, 11% had mild systemic reactions, and 31% had anaphylactic reactions, as defined by multisystem organ involvement or hypotension. Among patients with systemic reactions (mild or anaphylaxis), most (75%) were stung within 6 hours of ED arrival. While in the ED, 69% of systemic reaction patients received antihistamines, 50% systemic corticosteroids, and 12% epinephrine. Almost all systemic reaction patients (95%) were discharged to home. At ED discharge, 27% (95% CI, 22% to 33%) of systemic reaction patients received a prescription for self-injectable epinephrine. Only 20% (95% CI, 15% to 26%) had documentation of referral to an allergist.
Although guidelines suggest specific approaches for the emergency management of insect sting allergy, concordance with these guidelines appears low in patients with a severe insect sting reaction.
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ABSTRACT: This study was conducted to estimate the burden of non-canine-related bite and sting injuries in the U.S.; describe the affected population, injury severity, and bite or sting source; and provide considerations for prevention strategies. Data were from the 2001 through 2004 National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) (a stratified probability sample of U.S. hospitals). Records included information about age, body part affected, cause, diagnosis, disposition, and gender. Narrative descriptions were coded for the source of the bite or sting. Between 2001 and 2004, an estimated 3.6 million people were treated in emergency departments for injuries related to non-canine bites and stings. Results detail the reported sources of the bite or sting, and examine sources by gender and age group. Common sources included bees (162,000 cases annually), spiders (123,000 cases annually), and cats (66,000 cases annually). Female adults were more likely than male adults to be treated for cat bites. Although rare, of the known venomous snakebites, more than half (58.4%) of the patients were hospitalized. Our results demonstrate the public health burden of non-canine-related bite and sting injuries. More than 900,000 people were treated in emergency departments annually for non-canine bite or sting injuries, or roughly 1.7 injuries per minute. Treatment consumes substantial health-care resources. While preventing these injuries should be the first line of defense, resources could be conserved by educating the public about immediate first aid and when warning signs and symptoms indicate the need for professional or emergency care.Public Health Reports 12/2007; 122(6):764-75. · 1.64 Impact Factor
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ABSTRACT: The authors report first results of the stage one clinical trial performed with the Positron Emission Mammography-1(PEM-1) scanner. Patients selected are >20 years of age with no history of treatment for cancer, recently diagnosed with an unclassified tumour mass of <2 cm diameter in one breast. A 2 mCi (74 MBq) injection of 2-[18F]-fluoro-deoxy-2-D-glucose (FDG) is given 40 minutes prior to scanning. The scan is a two step process. (1) The patient's mammogram is obtained with the tumour and a co-registration tool in the field-of-view (FOV). (2) Without moving the patient, the PEM detectors are moved in and emission data is collected for up to 5 minutes. The mammogram is digitized and fused with the reconstructed PEM image. To date, the authors have scanned eleven patients. In one subject a tumour <1 cm in diameter was localised visually as a hot spot 1.2 cm×0.8 cm in two dimensions. There was close to 4:1 increase in the focal uptake of FDG at the tumour site. Knowing the thickness of the compressed breast one can locate the tumour depth within the breast. There have been five true-positive results×these subjects were all correctly diagnosed by PEM-1 as having breast cancer; four true-negative results these subjects tested negative for breast cancer with PEM-1 and were surgically confirmed as being cancer free. There have been two false-negative results-the reasons for these are discussed in the text. The PEM-1 system is a high resolution, high efficiency and affordable system which can produce emission images accurately co-registered with X-ray mammographic images using at most 1/5 the F18-FDG and imaging for at most 1/5 the time required when conventional PET instruments are usedNuclear Science Symposium, 1997. IEEE; 12/1997