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P008: Hereditary Angioedema Rapid Triage Tool (HAE-RT): translating clinical research into clinical practice

Published online by Cambridge University Press:  11 May 2018

S. Betschel
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
E. Avilla
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
S. Waserman
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
J. Badiou
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
K. Binkley
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
R. Borici-Mazi
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
J. Hebert
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
L. Howlett
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
A. Kanani
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
P. Keith
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
G. Lacuesta
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
W. Yang
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
A. Rowe
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON
P. Waite
Affiliation:
Department of Internal Medicine, University of Toronto Division of Clinical Immunology and Allergy St. Michael’s Hospital, Toronto, ON

Abstract

Introduction: Hereditary angioedema (HAE) patients (both diagnosed and undiagnosed) commonly present to the emergency department (ED). Presenting symptoms (swelling and pain) may be erroneously attributed to common allergic and gastrointestinal conditions resulting in major delays in diagnosis and appropriate treatment. No published tools currently exist for HAE screening and management in undiagnosed disease. The overall goal of the study was to develop a HAE-RT tool for ED settings. Methods: A two-phase mixed methods approach was used to develop the HAE-RT Tool including: Phase 1: A Delphi Study [HAE specialists (N=9) and National Patient Advocacy Group Members (N=3)] was conducted to reach consensus (80% agreement) on predictor variables to include. Phase 2: A retrospective chart review was conducted to assess the predictive findings of the predictor variables. A convenient sample of patients presenting with angioedema (with and without HAE) between January 2012 January 2017 were included in the study. Results: Of the 12 experts invited, 9 (75%) participated in the Delphi study. Of 8 HAE-specific predictive variables, 4 reached consensuses including: (1) recurrent angioedema; (2) absence of urticaria; (3) past recurrent abdominal pain/swelling; (4) response to allergic therapy. The retrospective study included 85 patients (N=46 with HAE; N=39 non-HAE; overall 72% female). HAE patients were significantly more likely to have a family history of HAE (72% vs 0%; P<0.0001); previous recurrent angioedema (96%; P<0.009); present with no hives (91%; P<0.036); previous recurrent abdominal pain (80%; P<0.0001); and only 2% responded positively to allergy treatments (P<0.0001). Conclusion: Our study emphasizes the importance of key stakeholder involvement and feedback to facilitate the prioritization of important information that must be included in the design of an HAE-RT tool. The next step is to observe the effect of the HAE-RT tool on patient triage in the ED.

Type
Poster Presentations
Copyright
Copyright © Canadian Association of Emergency Physicians 2018 

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