Outcomes of Emergency Department Anaphylaxis Visits from 2005 to 2014

BACKGROUND: Although the incidence of anaphylaxis appears to be increasing, trends in anaphylaxis-related health care utilization are not well understood. OBJECTIVE: To better understand the potential increasing health care burden, we analyzed the changes in anaphylaxis-related health care utilization, including emergency department (ED) discharges, observation stays, inpatient admissions, intensive care unit admissions, and endotracheal intubations. METHODS: We conducted an observational study examining outcomes of anaphylaxis-related ED visits between January 1, 2005, and December 31, 2014. We analyzed administrative claims data from OptumLabs Data Warehouse, which includes more than 100 million Medicare Advantage and privately insured enrollees in the United States. We studied trends in the proportions of ED-related anaphylaxis visits based on demographic characteristics, triggers, and ED disposition for our study population. RESULTS: Among 56,212 anaphylaxis-related ED visits during a 10-year period, the proportion of patient observation/inpatient admissions increased by 37.6% (P = .02), from 13.2% of anaphylaxis-related ED visits in 2005 to 18.2% in 2014. The proportion of patients admitted to the intensive care unit increased by 27.4% (P = .001), from 4.5% in 2005 to 5.8% in 2014. Proportions of endotracheal intubation increased by 145.2% (P < .001). CONCLUSIONS: The increasing proportions of observation/inpatient admissions, intensive care unit admissions, and endotracheal intubations suggest an increase in anaphylaxis severity. Enhanced awareness of these trends among patients, practitioners, and the community is necessary to create effective strategies to prevent anaphylaxis and decrease associated adverse consequences. (C) 2017 American Academy of Allergy, Asthma & Immunology