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Clinical Features and Outcomes Associated with Angioedema in the Emergency Department.
- Source :
- Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health; Sep2019, Vol. 20 Issue 5, p760-769, 10p
- Publication Year :
- 2019
-
Abstract
- Introduction: Angioedema represents self-limited, localized swelling of submucosal or subcutaneous tissues. While the underlying etiology may be undeterminable in the emergent setting, nonhistaminergic and histaminergic angioedema respond differently to therapeutic interventions, with implications for empiric treatment. Clinical features and outcome differences among nonhistaminergic vs histaminergic angioedema patients in the emergency department (ED) are poorly characterized. We aim to describe the clinical characteristics and outcomes among ED patients with angioedema by suspected etiology. Methods: This was a 10-year retrospective study of adult ED patients with angioedema, using data abstracted from the electronic health record. We evaluated univariable associations of select clinical features with etiology and used them to develop a multivariable logistic regression model for nonhistaminergic vs histaminergic angioedema. Results: Among 450 adult angioedema patients, the mean +/- standard deviation age was 57 +/- 18 years, and 264 (59%) were female. Among patients, 30% had suspected nonhistaminergic angioedema, 30% had suspected histaminergic angioedema, and 40% were of unknown etiology. As compared to histaminergic angioedema, nonhistaminergic angioedema was associated with angiotensin-converting enzyme inhibitors (ACEI) or use of angiotensin II receptor blockers (ARB) (odds ratio [OR] [60.9]; 95% confidence interval [CI], 23.16-160.14) and time of onset one hour or more prior to ED arrival (OR [5.91]; 95% CI, 1.87-18.70) and was inversely associated with urticaria (OR [0.05]; 95% CI, 0.02-0.15), dyspnea (OR [0.23]; 95% CI, 0.08-0.67), and periorbital or lip edema (OR [0.25]; 95% CI, 0.08-0.79 and OR [0.32]; 95% CI, 0.13-0.79, respectively). Conclusion: As compared to histaminergic angioedema, patients with nonhistaminergic angioedema were more likely to present one hour or more after symptom onset and take ACEI or ARB medications, and were less likely to have urticaria, dyspnea, or periorbital or lip angioedema. Identification of characteristics associated with the etiology of angioedema may assist providers in more rapidly initiating targeted therapies. [ABSTRACT FROM AUTHOR]
- Subjects :
- ANTIHISTAMINES
ANGIONEUROTIC edema
ACE inhibitors
COMPARATIVE studies
CONFIDENCE intervals
DYSPNEA
EMERGENCY medical services
ORBITAL diseases
HOSPITAL emergency services
MEDICAL records
PATIENTS
STATISTICS
TIME
URTICARIA
LIP diseases
MULTIPLE regression analysis
TREATMENT effectiveness
RETROSPECTIVE studies
ELECTRONIC health records
ANGIOTENSIN receptors
DESCRIPTIVE statistics
ACQUISITION of data methodology
ODDS ratio
EVALUATION
SYMPTOMS
THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 1936900X
- Volume :
- 20
- Issue :
- 5
- Database :
- Complementary Index
- Journal :
- Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
- Publication Type :
- Academic Journal
- Accession number :
- 138581201
- Full Text :
- https://doi.org/10.5811/westjem.2019.6.42852