C-CARE: comparing three years of anaphylaxis in children treated at the Montreal Children’s Hospital
Bibliographic record
Abstract
The Cross-Canada Anaphylaxis Registry (C-CARE) aims to examine burden, triggers, management and temporal trends in anaphylaxis. Over a three-year period (April 2011 to April 2014), data were collected on anaphylaxis cases at the Montreal Children’s Hospital emergency department (ED). Cases were recruited either prospectively or identified retrospectively based on chart review through ICD10 codes related to anaphylaxis. Logistic regressions were conducted to determine the association between sociodemographic and clinical characteristics and development of severe reactions as well as epinephrine use. Among 624 cases the median age was 5.7 years (IQR 2.4-11.7) and the majority (56.6%) were males. The percentage of anaphylaxis among all ED visits increased from 0.22% (95% CI 0.18%, 0.24%) in 2011 to 0.3% (95% CI 0.25%, 0.33%) in 2014, yielding a difference of 0.08% (95%CI, 0.03%, 0.13%). The major trigger was food (81.4%), mainly peanut and tree-nut. Most cases were moderate (70.2%) (breathing difficulties, stridor, diarrhea, crampy abdominal pain, recurrent vomiting). Of all reactions 28.7% were not administered epinephrine. Almost 95% were prescribed or had an epinephrine auto-injector (71.6% Epipen , 22.7% Allerject). Factors associated with severe reactions included history of peanut allergy, asthma and steroid treatment in ED. (Table 1 ) Management of anaphylaxis with at least one dose of epinephrine was associated with known food allergy and use of steroids in ED. Administration of two or more epinephrine doses in ED was less likely in those who received epinephrine outside ED and more likely with severe reactions, reactions triggered by tree-nut and in those treated with steroids in ED. The percentage of anaphylaxis cases among all ED visits increased by almost 40% over a three-year period. Prompt use of epinephrine may prevent use of subsequent multiple doses of epinephrine in ED. Reactions triggered by tree-nut are more prone to require treatment with multiple doses of epinephrine.
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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 | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".