A Novel Informatics Tool to Detect Periprocedural Antibiotic Allergy Adverse Events for Near Real-time Surveillance to Support Audit and Feedback.
A Novel Informatics Tool to Detect Periprocedural Antibiotic Allergy Adverse Events for Near Real-time Surveillance to Support Audit and Feedback.
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DOI：
10.1001/jamanetworkopen.2023.13964
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发表时间：
2023-05-01
影响因子：
13.8
通讯作者：
Branch-Elliman, Westyn
中科院分区：
文献类型：
--
作者：
Dassum, Samira Reyes;Mull, Hillary J.;Golenbock, Samuel;Lamkin, Rebecca P.;Epshtein, Isabella;Shin, Marlena H.;Strymish, Judith M.;Blumenthal, Kimberly G.;Colborn, Kathryn;Branch-Elliman, Westyn
信息学工具能否提高抗生素过敏型事件的检测？在这项对36344例接受心血管植入式电子器械手术的患者进行的队列研究中，开发了一种具有高阳性预测值的电子算法，可用于近实时测量围手术期抗生素过敏型事件的发生率。大多数抗生素过敏型反应的严重程度为中度。本研究中开发的算法可用于检测抗生素过敏型反应何时发生，以提供有关危害的直接临床反馈。这项队列研究描述了一种信息学工具的开发，以改善围手术期抗生素过敏不良事件的检测。用于识别何时发生过敏性反应并将反应与药物暴露联系起来的标准化流程有限。开发一种信息学工具，以提高抗生素过敏型事件的检测。这项回顾性队列研究于2015年10月1日至2019年9月30日进行，分析了2021年7月1日至2022年1月31日期间的数据。该研究在退伍军人事务部医院进行，患者接受心血管植入式电子设备（CIED）手术并接受围手术期抗生素预防。将队列分为训练和测试队列，手动审查病例以确定是否存在过敏型反应及其严重程度。先验选择可能指示过敏型反应的变量，包括在Veteran Affair的过敏反应跟踪（ART）系统中输入的过敏（历史[报告]或观察到的）、过敏诊断代码、治疗过敏反应的药物以及临床记录中指示潜在过敏型反应的关键词和短语的文本搜索。在训练队列上迭代开发检测过敏型反应事件的模型，然后应用于测试队列。评估了算法测试特征。术前和术后预防性抗生素给药。抗生素过敏性反应。36344例患者的队列包括34703例抗生素暴露的CIED手术（平均[SD]年龄，72 [10]岁; 34008例[98%]男性患者）;术后预防的中位持续时间为4天（IQR，2-7天;最长45天）。最终的算法包括7个变量：退伍军人事务医院ART中的条目，或者历史（比值比[OR]，42.37; 95% CI，11.33-158.43）或观察到（OR，175.10; 95% CI，44.84-683.76）;“影响皮肤的症状”的Phe代码（OR，8.49; 95% CI，1.90-37.82），“荨麻疹”（OR，7.01; 95% CI，1.76-27.89）和“抗生素过敏或不良事件”（OR，11.84; 95%CI，2.88-48.69）;临床记录中的关键词检测（OR，3.21; 95%CI，1.27-8.08）;抗组胺药单独或联合给药（OR，6.51; 95%CI，1.90-22.30）。在最终模型中，确定抗生素过敏型反应的估计概率为30%或更高;阳性预测值为61%（95% CI，45%-76%）;敏感性为87%（95% CI，70%-96%）。在这项对接受围手术期抗生素预防的患者进行的回顾性队列研究中，开发了一种高灵敏度的算法，用于检测偶发抗生素过敏型反应，可用于提供临床医生关于不必要延长抗生素暴露的抗生素危害的反馈。
Can an informatics tool improve detection of antibiotic allergic-type events? In this cohort study of 36 344 patients who underwent cardiovascular implantable electronic device procedures, an electronic algorithm with high positive predictive value was developed that can be used to measure the occurrence of periprocedural antibiotic allergic-type events in near real-time. Most antibiotic allergic-type reactions were moderate in severity. The algorithm developed in this study could be used to detect when antibiotic allergic-type reactions occur to provide direct clinician feedback about harms. This cohort study describes the development of an informatics tool to improve detection of periprocedural antibiotic allergy adverse events. Standardized processes for identifying when allergic-type reactions occur and linking reactions to drug exposures are limited. To develop an informatics tool to improve detection of antibiotic allergic-type events. This retrospective cohort study was conducted from October 1, 2015, to September 30, 2019, with data analyzed between July 1, 2021, and January 31, 2022. The study was conducted across Veteran Affairs hospitals among patients who underwent cardiovascular implantable electronic device (CIED) procedures and received periprocedural antibiotic prophylaxis. The cohort was split into training and test cohorts, and cases were manually reviewed to determine presence of allergic-type reaction and its severity. Variables potentially indicative of allergic-type reactions were selected a priori and included allergies entered in the Veteran Affair’s Allergy Reaction Tracking (ART) system (either historical [reported] or observed), allergy diagnosis codes, medications administered to treat allergic reactions, and text searches of clinical notes for keywords and phrases indicative of a potential allergic-type reaction. A model to detect allergic-type reaction events was iteratively developed on the training cohort and then applied to the test cohort. Algorithm test characteristics were assessed. Preprocedural and postprocedural prophylactic antibiotic administration. Antibiotic allergic-type reactions. The cohort of 36 344 patients included 34 703 CIED procedures with antibiotic exposures (mean [SD] age, 72 [10] years; 34 008 [98%] male patients); median duration of postprocedural prophylaxis was 4 days (IQR, 2-7 days; maximum, 45 days). The final algorithm included 7 variables: entries in the Veteran Affair’s hospitals ART, either historic (odds ratio [OR], 42.37; 95% CI, 11.33-158.43) or observed (OR, 175.10; 95% CI, 44.84-683.76); PheCodes for “symptoms affecting skin” (OR, 8.49; 95% CI, 1.90-37.82), “urticaria” (OR, 7.01; 95% CI, 1.76-27.89), and “allergy or adverse event to an antibiotic” (OR, 11.84, 95% CI, 2.88-48.69); keyword detection in clinical notes (OR, 3.21; 95% CI, 1.27-8.08); and antihistamine administration alone or in combination (OR, 6.51; 95% CI, 1.90-22.30). In the final model, antibiotic allergic-type reactions were identified with an estimated probability of 30% or more; positive predictive value was 61% (95% CI, 45%-76%); and sensitivity was 87% (95% CI, 70%-96%). In this retrospective cohort study of patients receiving periprocedural antibiotic prophylaxis, an algorithm with a high sensitivity to detect incident antibiotic allergic-type reactions that can be used to provide clinician feedback about antibiotic harms from unnecessarily prolonged antibiotic exposures was developed.
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影响因子：
46.9
作者：
通讯作者：
--
影响因子：
11.8
作者：
MacFadden, Derek R.;LaDelfa, Anthony;Leis, Jerome A.
通讯作者：
Leis, Jerome A.
影响因子：
2
作者：
Bratzler, Dale W.;Dellinger, E. Patchen;Weinstein, Robert A.
通讯作者：
Weinstein, Robert A.
DOI：
10.1016/j.jaip.2018.07.022
发表时间：
2019-01-01
影响因子：
9.4
作者：
Saff, Rebecca R.;Li, Yu;Banerji, Aleena
通讯作者：
Banerji, Aleena
影响因子：
1.1
作者：
Sanchez-Borges, Mario;Ansotegui, Ignacio;Cox, Linda
通讯作者：
Cox, Linda