Impact of an electronic consultant system on hypersensitivity reactions to iodinated radiocontrast media: an observational study

Yang, Min; Choi, Seo-Young; Song, Woo Jung; Kim, Sae Hoon; Kang, Hye Ryun; Park, Heung-Woo; Cho, Sang Heon; Min, Kyung Up; Kim, Jae Hyoung; Chang, Yoon‐Seok

doi:10.1136/postgradmedj-2013-132538

Cited by 10 publications

(15 citation statements)

References 29 publications

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“…The incidence rate of immediate HR to nonionic RCM is reported to be 0.7%–3% in the world [ 1 ] and especially in Asia Pacific region, it is reported to be 0.16%–2.21% in recent 10 years [ 4 5 6 7 8 ]. To use RCM safely, prevention strategies should be considered for those subjects who have a history of previous RCM-induced HRs before readministration of RCM because they are highly susceptible to recurrence [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

The efficacy of single premedication with antihistamines for radiocontrast media hypersensitivity

Lee

Park

Cho

et al. 2016

Asia Pacific Allergy

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BackgroundSingle premedication with antihistamines for radiocontrast media (RCM) hypersensitivity is frequently used in real world at the emergent situation although its efficacy is not proven.ObjectiveTo evaluate the effect of intravenous antihistamines as a premedication in general population who had experience of mild adverse reactions to iodinated RCM.MethodsA retrospective observational study on 14,785 subjects who had RCM-enhanced computed tomography scans between January 2014 and December 2015 in Seoul National University Hospital Gangnam Healthcare Center, Seoul, South Korea.ResultsAmong 453 subjects who had a history of mild RCM-induced hypersensitivity reactions, 273 subjects had a single premedication of intravenous antihistamine. When comparing antihistamine-premedication group and nonpremedication group, there is no protective effect of antihistamines on the incidence rate and severity of hypersensitivity (10.6% vs. 11.7%, p = 0.729).ConclusionThe clinical efficacy of a single premedication of antihistamines for mild RCM-induced hypersensitivity was not confirmed.

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Section: Discussionmentioning

confidence: 99%

The efficacy of single premedication with antihistamines for radiocontrast media hypersensitivity

Lee

Park

Cho

et al. 2016

Asia Pacific Allergy

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“…Further details of our consultation support system have been described elsewhere. 15 Our consultation support system has worked excellently and significantly decreased the incidence of RCM hypersensitivity (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.49–0.71; P <0.001) according to our analysis using a generalized estimating equation (GEE) to adjust for repeated exposure. However, we failed to show a reduction in the occurrence of breakthrough reactions among patients with previous RCM hypersensitivity and could not explain the reason for the reduced incidence rate.…”

Section: Introductionmentioning

confidence: 85%

“…We previously reported on the effectiveness of a RCM hypersensitivity alert system embedded in our EMR. 15 Our RCM hypersensitivity alert system communicates with physicians through a pop-up window when they prescribe a RCM-enhanced computed tomography (CT) scan for a patient with previous RCM hypersensitivity. Then, they could decide whether to consult to an allergist, prescribe premedication themselves, or ignore the pop-up window and keep ordering RCM-enhanced CT scan.…”

Section: Introductionmentioning

confidence: 99%

Electronic Consultation Support System for Radiocontrast Media Hypersensitivity Changes Clinicians' Behavior

Yang

Choi

Song

et al. 2018

Allergy Asthma Immunol Res

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PurposePatients with a history of radiocontrast media (RCM) hypersensitivity can be overlooked, resulting in repeated reactions. Therefore, a consultation support system for RCM hypersensitivity has been in operation at Seoul National University Bundang Hospital since December 2011. We analyzed the effect of this system on physicians' practice.MethodsA retrospective study was conducted on patients with previous RCM reactions (December 1, 2010 to November 30, 2012). The control period was December 2010 to November 2011, and the intervention period was December 2011 to November 2012. The primary outcome was the composite outcome of premedication and consultation. Premedication was defined as preventive medication prescribed by the physician who ordered RCM-enhanced computed tomography (CT) at the same time. The secondary outcome was the recurrence rate after using the consultation support system.ResultsA total of 189 clinicians prescribed 913 CT scans during the control period and 225 clinicians performed 1,153 examinations during the intervention period. The odds ratio (OR) of achieving the composite outcome increased significantly after use of the consultation support system (OR, 1.54; 95% confidence interval [CI], 1.15–2.05). Clinicians in both medical (OR, 1.48; 95% CI, 1.06–2.07) and surgical (OR, 2.07; 95% CI, 1.24–3.46) departments showed significant changes in their behavior, whereas those in the emergency department did not (OR, 1.07; 95% CI, 0.41–2.78). Professors (OR, 1.47; 95% CI, 1.06–2.04) and trainees (OR, 1.97, 95% CI, 1.22–3.18) showed significant changes in their behavior toward patients with previous RCM reactions. The behavior of 86 clinicians who ordered CT scans during both the control and intervention periods was unchanged.ConclusionsThe consultation support system for those with previous RCM hypersensitivity reactions changed physicians' practice patterns and decreased recurrent RCM hypersensitivity reactions as well.

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“…When you order computed tomography scans using RCM, it is important to find out those who had a history of RCM induced hypersensitivity reactions. A clinical decision supporting system embedded in the electronic medical record system may help [ 7 ]. If it is impossible to avoid the use of RCM, the preventive measures are used, for example, 50 mg of oral prednisolone at 13 hours, 7 hours and an hour before injection of RCM, and 4 mg of chlorpheniramine at an hour before the injection if a patient has previous history of severe immediate type RCM hypersensitivity [ 6 ].…”

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confidence: 99%

“…Advances in technology are changing the future of medicine. Clinical decision supporting systems have been developed to help clinicians make informed management decisions [ 7 9 ]. The platform of the clinical decision supporting system has been evolved from simple algorithms to artificial intelligence with neural networking systems.…”

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confidence: 99%

Advances in technology are changing the future of medicine

Chang

2016

Asia Pacific Allergy

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Impact of an electronic consultant system on hypersensitivity reactions to iodinated radiocontrast media: an observational study

Abstract: The introduction of the consultation support system reduced the incidence of hypersensitivity reactions to RCM and increased the use of premedication in patients with known hypersensitivity to RCM.

Cited by 10 publications

References 29 publications

The efficacy of single premedication with antihistamines for radiocontrast media hypersensitivity

The efficacy of single premedication with antihistamines for radiocontrast media hypersensitivity

Electronic Consultation Support System for Radiocontrast Media Hypersensitivity Changes Clinicians' Behavior

Advances in technology are changing the future of medicine

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