دورية أكاديمية
أعرض في EDS

A Novel Informatics Tool to Detect Periprocedural Antibiotic Allergy Adverse Events for Near Real-time Surveillance to Support Audit and Feedback.

التفاصيل البيبلوغرافية
العنوان: A Novel Informatics Tool to Detect Periprocedural Antibiotic Allergy Adverse Events for Near Real-time Surveillance to Support Audit and Feedback.
المؤلفون: Reyes Dassum S; Department of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts., Mull HJ; Center for Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts.; Department of Surgery, Boston University School of Medicine, Boston, Massachusetts., Golenbock S; Center for Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts., Lamkin RP; Center for Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts., Epshtein I; Center for Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts., Shin MH; Center for Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts., Strymish JM; Section of Infectious Disease, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts., Blumenthal KG; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston.; Harvard Medical School, Boston, Massachusetts., Colborn K; Department of Surgery, University of Colorado, Aurora., Branch-Elliman W; Center for Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts.; Section of Infectious Disease, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts.
المصدر: JAMA network open [JAMA Netw Open] 2023 May 01; Vol. 6 (5), pp. e2313964. Date of Electronic Publication: 2023 May 01.
نوع المنشور: Journal Article; Research Support, U.S. Gov't, Non-P.H.S.
اللغة: English
بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Chicago, IL : American Medical Association, [2018]-
مواضيع طبية MeSH: Drug Hypersensitivity*/diagnosis , Drug Hypersensitivity*/epidemiology , Hypersensitivity*, Humans ; Male ; Aged ; Female ; Retrospective Studies ; Feedback ; Anti-Bacterial Agents/adverse effects
مستخلص: Importance: Standardized processes for identifying when allergic-type reactions occur and linking reactions to drug exposures are limited.
Objective: To develop an informatics tool to improve detection of antibiotic allergic-type events.
Design, Setting, and Participants: 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.
Exposure: Preprocedural and postprocedural prophylactic antibiotic administration.
Main Outcomes and Measures: Antibiotic allergic-type reactions.
Results: 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%).
Conclusions and Relevance: 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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معلومات مُعتمدة: I01 HX003234 United States HX HSRD VA
المشرفين على المادة: 0 (Anti-Bacterial Agents)
تواريخ الأحداث: Date Created: 20230517 Date Completed: 20230519 Latest Revision: 20240229
رمز التحديث: 20240229
مُعرف محوري في PubMed: PMC10193175
DOI: 10.1001/jamanetworkopen.2023.13964
PMID: 37195660
قاعدة البيانات: MEDLINE
الوصف
تدمد:2574-3805
DOI:10.1001/jamanetworkopen.2023.13964