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Clinical Features and Outcomes Associated with Angioedema in the Emergency Department
- Source :
- Western Journal of Emergency Medicine, Western Journal of Emergency Medicine, Vol 20, Iss 5 (2019)
- Publication Year :
- 2019
-
Abstract
- Author(s): Sandefur, Benjamin J.; Oliveira J. e Silva, Lucas; Lohse, Christine M.; Goyal, Kiran A.; Barbara, David W.; Castaneda-Guarderas, Ana; Liu, Xiao-wei; Campbell, Ronna L. | 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.
- Subjects :
- Male
medicine.medical_specialty
Critical Care
lcsh:Medicine
Angiotensin-Converting Enzyme Inhibitors
03 medical and health sciences
0302 clinical medicine
immune system diseases
Edema
Medicine
Electronic Health Records
Humans
030212 general & internal medicine
cardiovascular diseases
Angioedema
skin and connective tissue diseases
Retrospective Studies
Original Research
business.industry
lcsh:R
lcsh:Medical emergencies. Critical care. Intensive care. First aid
Histaminergic
Disease Management
030208 emergency & critical care medicine
Retrospective cohort study
lcsh:RC86-88.9
General Medicine
Emergency department
Odds ratio
Middle Aged
Dermatology
Confidence interval
Emergency Medicine
Etiology
Female
medicine.symptom
business
Emergency Service, Hospital
Follow-Up Studies
Forecasting
Subjects
Details
- ISSN :
- 19369018
- Volume :
- 20
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- The western journal of emergency medicine
- Accession number :
- edsair.doi.dedup.....225557688c46ef06ad371a2997010de5