Allergy Asthma Immunol Res.  2018 Mar;10(2):165-171. 10.4168/aair.2018.10.2.165.

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

• Yang MS
• Choi SI
• Song WJ
• Kim SH
• Cho SH
• Min KU
• Kim JH
• Chang YS

• KMID: 2402976
• DOI: http://doi.org/10.4168/aair.2018.10.2.165

Abstract

PURPOSE
Patients 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.
METHODS
A 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.
RESULTS
A 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.
CONCLUSIONS
The consultation support system for those with previous RCM hypersensitivity reactions changed physicians' practice patterns and decreased recurrent RCM hypersensitivity reactions as well.

Keyword

Drug hypersensitivity; radiocontrast media; clinical decision support system

MeSH Terms

Contrast Media*
Drug Hypersensitivity
Emergency Service, Hospital
Humans
Hypersensitivity*
Odds Ratio
Practice Patterns, Physicians'
Premedication
Recurrence
Retrospective Studies
Seoul
Tomography, X-Ray Computed
Contrast Media

Figure

• 

  Figure Comparison of the frequencies of achieving outcomes before and after the initiation of the consultation support system. The increasing trends were all similar even when subjects were differently stratified: all doctors (A), specialty group (B), and career group (C).

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