Angioedema in the emergency department: clinical presentation and outcomes
Bibliographic record
Abstract
A retrospective data review of all ED visits to two academic tertiary care centers over the period of July 1, 2007 to March 31, 2012 was conducted. Records selected for full review met the inclusion criteria of documented visible swelling and one of the ICD-10 diagnostic codes for anaphylactic shock, angioneurotic edema, allergy unspecified, defects in the complement system, or unspecified drug adverse effect. Age, sex, cause and site of swelling, comorbidities, medications, allergies, admissions, etc. were collected via a standardized form. Bivariate and multivariate analyses were performed using chi-square tests. Potential predictors for admission were identified using a multivariate logistic regression model. A p value less than 0.05 was considered significant. This study was approved by Queens University Ethics Committee. Medical records from 527 ED visits by 455 patients were included in the study, and 21 patients were admitted. Angioedema was encountered at annual rate of 10 per 10000 ED visits. Patients who presented with urticaria (29.8%) were significantly more likely to present with lip swelling ( p =0.001) and extremity swelling ( p =0.008), while the absence of urticaria correlated with tongue swelling ( p =0.001). The mean duration of stay in ED was significantly longer in patients with urticaria ( p <0.001), but the presence of urticaria did not predict admission. A probable cause was identified in 48.8% of visits. Periorbital angioedema was associated with environmental, contact, and insect sting allergy ( p <0.001). 58.3% of patients with angioedema due to drug allergy had lip angioedema ( p =0.032). C1 esterase inhibitor deficiency was most frequently associated with a history of previous episodes. Several factors were found to predict admission, including NSAID-induced angioedema (OR=15.3), epinephrine treatment (OR=8.34), hypotension (OR=15.7), multiple site angioedema (OR=4.25), pharyngeal angioedema (OR=1.23), and tongue angioedema (OR=4.62). This large cohort retrospective review confirms cause-clinical associations in angioedema and demonstrates novel predictors of morbidity, with implications in clinical practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".