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IntroductionAngioedema 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.MethodsThis 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.ResultsAmong 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).ConclusionAs 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.

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Study Objectives: To study the effectiveness of a mobile app-based strategy to improve door-to-needle time in the treatment of acute ischemic stroke in an emergency department in Kerala, India.Methods: This was a study of consecutively presenting patients who were admitted to the emergency department at Baby Memorial Hospital between April 2017 -March 2018 with acute stroke. The mobile application (app) included fields for patient parameters, a timer, the NIH stroke scale (NIHSS), the thrombolysis checklist and a tPA (tissue plasminogen activator) dose calculator. The app also enabled team synchronization by notifying all on-call members and team leaders of the patient movement in real time, along with sharing of radiological images.Door to needle time (DNT) captured from the app was entered in a spreadsheet and compared to previous values from our center. Mean values were compared using the unpaired t test (2-tailed).Results: A total of 62 patients were thrombolysed during the time period using the mobile app. The mean DNT was 45 min with 89% being thrombolysed within 60 minutes and 57% being thrombolysed within 45 minutes.These patients were compared with 100 consecutive patients who were thrombolysed in the months prior to April 2017, where the mean DNT was 57 min, with 67% thrombolysed within 60 minutes and 47% being thrombolysed within 45 minutes.A mean DNT decrease of 12 minutes was seen with 1.3 x increase in DNT < 60 min. This difference was statistically significant (p¼0.0104, unpaired t test). The causes of delay were identified and included delays in patient shifting and imaging. Conclusions: We have been able to demonstrate significant improvement in doorto-needle time by using a mobile app as a tool to improve team performance; in addition, the app allowed us to identify causes of delay.