Role of comorbid conditions in asthma hospitalizations in the south of France.

International audienceBACKGROUND: Reasons for asthma hospitalizations are dynamic and complex. Comorbid conditions are important contributors to most chronic diseases today. We aim to characterize and describe risk factors associated with hospitalizations due to asthma in the Languedoc-Roussillon region (France) in 2009. METHODS: Programme de Médicalisation des Systèmes d'Information (PMSI) data records from 2009 were sorted using selected International Classification of Diseases (ICD10) codes eliciting three groups of asthma hospitalizations according to acute severity. All available data including demographics, comorbid conditions, past hospitalizations either related or unrelated to asthma, seasonality and distance to medical facilities were used to compare the subjects within the three groups. RESULTS: One thousand two hundred and eighty-nine hospitalizations due to asthma exacerbation were found, concerning 1122 patients. We observed significant differences within the groups, using univariate analysis, concerning duration of hospitalizations (mean ± SD, 4.9 ± 5.9 days vs 6.4 ± 6.8 vs 15.8 ± 16.8, P < 0.001), deaths (percentage, 0.03% vs 1.50% vs 9.20%, P < 0.001) and numbers of comorbid conditions (0.80 ± 0.95 vs 0.75 ± 0.97 vs 1.74 ± 1.36, P < 0.001). Recurrent admissions for asthma during the period 2006-2008 were significantly more frequent in the more severe group (1.93 ± 3.91 vs 2.56 ± 4.47 vs 2.81 ± 3.97, P = 0.006). In the multivariate model, age and number of comorbid conditions were independently associated with severe hospitalizations and deaths. CONCLUSIONS: Asthma hospitalizations can be appropriately assessed using PMSI coding databases. In this study, age and the presence of comorbid conditions are the major risk factors for asthma hospitalizations and deaths

Optimal step doses for drug provocation tests to prove beta-lactam hypersensitivity

International audienceBACKGROUND: Drug provocation tests (DPT) are commonly performed as part of β-lactam (BL) allergy workup, in case of negative skin tests (ST) and in the absence of contraindications. The recommendations of learned societies have created a frame for DPT performance, but protocols vary widely between centres, generating various hypothesis-driven protocols (i.e. empirical dosing, driven by both safety concerns and practical aspects). METHODS: The primary objective of this retrospective analysis was to detect eliciting dose thresholds (reactive doses) during BL DPT, using the survival analysis method, in order to suggest optimal step doses. Our secondary objective was to evaluate the safety of our 30-min incremental 1-day protocol. The study included all the patients explored in the Allergy Unit of the University Hospital of Montpellier (France), between September 1996 and July 2015 for a suspicion of drug hypersensitivity reaction to BLs, with negative ST and positive DPT. RESULTS: During the study period, 182 positive DPT (accounting for 171 hypersensitive patients) were analysed. We identified eliciting thresholds, and we suggest the following steps for DPT to BLs: 5-15-30-50% of daily therapeutic dose (with additional lower steps for index reactions of anaphylaxis). We confirm the safety of 1-day protocol for immediate and mild nonimmediate reactors, for both children and adults, with a surveillance period of 2 h after the last administered dose, and a prolonged surveillance after discharge of 48 h. CONCLUSION: This data-driven approach in designing DPT protocols is a step forward in improving DPT standardization, starting with the most frequently tested drugs, BL antibiotics

Field-testing the new anaphylaxis’ classification for the who International Classification of Diseases (ICD)-11 revision

Joint Allergy Academies: American Academy of Allergy Asthma and Immunology (AAAAI), European Academy of Allergy and Clinical Immunology (EAACI), World Allergy Organization (WAO), American College of Allergy Asthma and Immunology (ACAAI), Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI), Latin American Society of Allergy, Asthma and Immunology (SLAAI)International audienceBackgroundIn order to consolidate the new classification model addressed to the allergic and hypersensitivity conditions according to the International Classification of Diseases (ICD)-11 revision timeline, we here propose real-life application of quality assurance methodology to evaluate sensitivity and accuracy of the “Anaphylaxis” subsection.MethodsWe applied field-testing methodology by analyzing all the consecutive inpatients’ files documented as allergies from the University Hospital of Montpellier electronic database for the period of one year. The files clinically validated as being anaphylaxis were manually blind-coded under ICD-10 and current ICD-11 beta draft. The correspondence of coding and the impressions regarding sensibility were evaluated.ResultsFrom all 2,318 files related to allergic or hypersensitivity conditions, 673 had some of the anaphylaxis ICD-10 codes; 309 files (46%) from 209 patients had anaphylaxis and allergic or hypersensitivity comorbidities description. The correspondence between the two coders was perfect for 162 codes from all 309 entities (52.4%) (Cohen-kappa value 0.63) with the ICD-10 and for 221 codes (71.5%) (Cohen-kappa value 0.77) with the ICD-11. There was a high agreement regarding sensibility of the ICD-11 usability (Cohen-kappa value 0.75).ConclusionWe here propose the first attempt of real-life application to validate the new ICD-11 “Anaphylaxis” subsection. Clearer was the improvement of accuracy reaching 71.5% of agreement when ICD-11 was used. By allowing all the relevant diagnostic terms for anaphylaxis to be included into the ICD-11 framework, WHO has recognized their importance not only to clinicians but also to epidemiologists, statisticians, health care planners and other stakeholders

Évaluation de l’acceptabilité du point de vue du médecin traitant et de la faisabilité de la prise en charge ambulatoire de l’embolie pulmonaire

International audienceRationnel : En France, la prise en charge initiale des embolies pulmonaires (EP) est hospitalière. Les dernières recommandations suggèrent une prise en charge ambulatoire des EP stables. Cependant, le parcours de soins ambulatoire reste à déterminer ainsi que l’acceptabilité pour le médecin traitant (MT) de ce changement de pratique.Objectifs : Déterminer : (1) la proportion de patients éligibles à une prise en charge ambulatoire et les raisons d’hospitalisation des EP stables ; (2) l’acceptabilité pour le MT d’une prise en charge ambulatoire de l’EP et le parcours de soins souhaité.Méthode : Étude prospective observationnelle réalisée au CHU de Montpellier de mai 2012 à août 2013 en 2 parties : (1) étude hospitalière auprès des patients présentant une EP extrahospitalière ; (2) enquête parcours de soins auprès des MT des patients.Résultats : Étude hospitalière : 99,1 % (n = 211) des patients inclus ont été hospitalisés mais seuls 14,1 % (n = 30) présentaient tous les critères médicaux et sociaux pour une prise en charge ambulatoire. Enquête « parcours de soins » : 68,3 % (n = 112) des MT étaient favorables à une prise en charge ambulatoire d’autant plus qu’ils étaient âgés de 40–54 ans et qu’ils prenaient déjà en charge seuls leurs patients à la sortie de l’hôpital. Cent trente-neuf (84,8 %) médecins souhaitaient une prise en charge collaborative avec une visite de suivi à une semaine auprès d’un spécialiste des maladies vasculaires.Conclusion : Peu de patients pris en charge au CHU de Montpellier pour une EP sont éligibles à un traitement ambulatoire. Les MT sont favorables à une telle prise en charge, si celle-ci est collaborative