Association between penicillin allergy labels and serious adverse events in hospitalized patients: a systematic review and meta-analysis
Bibliographic record
Abstract
Background To date, several studies have demonstrated that erroneous labeling of Penicillin allergy (PAL) can significantly impact treatment options and result in adverse clinical outcomes, while other studies have reported no negative effects. Therefore, to systematically evaluate these effects and investigate the association between adverse clinical outcomes and the Penicillin label, we conducted this meta-analysis. Method Searches were conducted in the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to 13 July 2024. The search strategy utilized terms (“antibiotic allergy label,” “penicillin allergy label,” and “allergy label”) and (“death,” “readmission,” “adverse outcome,” and “clinical adverse outcome”). In the study selection process, the PICOS framework and stringent inclusion/exclusion criteria were applied. The quality of the initially included studies was independently assessed using the Newcastle-Ottawa Scale (NOS). Data from the included studies, including relative risk (RR) and 95% confidence intervals (CI), were extracted and analyzed using Stata 16.0. Sensitivity analyses were conducted to validate the results. Heterogeneity was assessed using the I 2 and Cochrane Q tests, and publication bias was evaluated using Egger’s test and funnel plot analysis. Results A total of 497 relevant studies were identified through four databases. Following a thorough screening process, 11 studies encompassing 1,200,785 participants were ultimately included. The combined evidence suggests that penicillin allergy labeling is associated with increased mortality RR = 1.06 (95% CI 1.06–1.07, I 2 = 0.00%), acute heart failure (RR = 1.19, 95% CI 1.09–1.30, τ 2 = 0.00, I 2 = 92.39%), ICU events (RR = 1.10, 95% CI 1.01–1.19, τ 2 = 0.00, I 2 = 57.09%), and mechanical ventilation events (RR = 1.16, 95% CI 1.09–1.24, τ 2 = 0.00, I 2 = 23.11%). Additionally, there was no significant association with readmissions (RR = 1.05, 95% CI 0.95–1.16, I 2 = 0.00%). Conclusion Our findings indicate that penicillin allergy labels are associated with an increased risk of mortality in patients, as well as being linked to acute heart failure, heightened ICU requirements, and mechanical ventilation. Systematic Review Registration: PROSPERO, identifier CRD42024571535. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202457153 .
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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 | 0.019 | 0.047 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.039 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| 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".