Emergency Department Corticosteroid Use for Allergy or Anaphylaxis Is Not Associated With Decreased Relapses
Emergency Department Corticosteroid Use for Allergy or Anaphylaxis Is Not Associated With Decreased Relapses
复制标题
DOI：
10.1016/j.annemergmed.2015.03.003
复制
发表时间：
2015-10-01
影响因子：
6.2
通讯作者：
Scheuermeyer, Frank X.
中科院分区：
文献类型：
--
作者：
Grunau, Brian E.;Wiens, Matthew O.;Scheuermeyer, Frank X.
研究目的：皮质类固醇（类固醇）通常用于缓解症状，并防止过敏反应的急诊科（艾德）患者的后续反应，尽管缺乏证据支持其使用。我们试图确定类固醇管理与改善临床outcomes.Methods：成人过敏相关的遭遇，以2个城市ED在5年的时间内被确定为“过敏反应”或“过敏反应”分类。“区域和省级数据库确定了随后的艾德就诊或7天内的死亡。主要结果是过敏相关的艾德重访类固醇和非类固醇暴露组，调整潜在的混杂因素与倾向评分分析;次要结果包括临床重要的双相反应和deaths.Results的数量：2701遭遇（473过敏），包括48%的类固醇治疗。接受和未接受类固醇治疗的患者中，过敏相关艾德再访率分别为5.8%和6.7%（校正比值比[OR] 0.91; 95%置信区间[CI] 0.64 - 1.28），需要治疗的患者数（NNT）为176例（95% CI NNT为获益39例至无穷大，NNT为损害65例）。速发型过敏反应亚组的校正OR为1.12（95% CI 0.41 - 3.27）。在过敏反应组中，调整后的OR为0.91（95% CI 0.63至1.31），NNT获益为173（95% CI NNT获益38至无穷大至NNT损害58）。在类固醇和非类固醇组中，分别有4例和1例临床重要的双相反应。无死亡。结论：在过敏反应或过敏反应的艾德患者中，皮质类固醇的使用与7天内复发率降低不相关。版权所有（C）2015美国急诊医师学会。
Study objective: Corticosteroids (steroids) are often used to mitigate symptoms and prevent subsequent reactions in emergency department (ED) patients with allergic reactions, despite a lack of evidence to support their use. We sought to determine the association of steroid administration with improved clinical outcomes.Methods: Adult allergy-related encounters to 2 urban EDs during a 5-year period were identified and classified as "anaphylaxis" or "allergic reaction." Regional and provincial databases identified subsequent ED visits or deaths within a 7-day period. The primary outcome was allergy-related ED revisits in the steroid- and nonsteroid-exposed groups, adjusting for potential confounders with a propensity score analysis; secondary outcomes included the number of clinically important biphasic reactions and deaths.Results: Two thousand seven hundred one encounters (473 anaphylactic) were included; 48% were treated with steroids. Allergy-related ED revisits occurred in 5.8% and 6.7% of patients treated with and without steroids, respectively (adjusted odds ratio [OR] 0.91; 95% confidence interval [Cl] 0.64 to 1.28), with a number needed to treat (NNT) to benefit of 176 (95% CI NNT to benefit 39 to infinity to NNT to harm 65). The adjusted OR in the anaphylaxis subgroup was 1.12 (95% Cl 0.41 to 3.27). In the allergic reaction group, the adjusted OR was 0.91 (95% Cl 0.63 to 1.31), with an NNT to benefit of 173 (95% Cl NNT to benefit 38 to infinity to NNT to harm 58). In the steroid and nonsteroid groups, there were 4 and 1 clinically important biphasic reactions, respectively. There were no deaths.Conclusion: Among ED patients with allergic reactions or anaphylaxis, corticosteroid use was not associated with decreased relapses to additional care within 7 days. Copyright (C) 2015 by the American College of Emergency Physicians.