Characteristics and Outcomes of Anaphylaxis in Emergency Department Visits Among Older Adults.

Abstract

Limited data exist on anaphylaxis characteristics and outcomes in older adults. To compare triggers, presentation, management, and outcomes of anaphylaxis emergency department (ED) visits between older adults (≥65 y) and younger adults (18-64 y) in a prehospital setting and the ED. This cohort study included ED visits among adults meeting anaphylaxis diagnostic criteria from April 2008 to December 2022. Visit characteristics and outcomes were analyzed by age group using χ² analysis and multivariable logistic regression. Among 1,422 patient visits, 212 (14.9%) involved older adults. Compared with younger adults, visits among older adults were more likely to involve anaphylaxis from medications (34.0% vs 21.3%; odds ratio [OR] 1.85; 95% confidence interval [95% CI] 1.34-2.55) and intravenous contrast (13.2% vs 5.6%; OR 2.50; 95% CI 1.55-4.04). Older adult visits had increased odds of severe anaphylaxis (adjusted odds ratio [OR] 1.57; 95% CI 1.12-2.21), including endotracheal intubation (aOR 6.24; 95% CI 2.69-14.48) and admission to the hospital or intensive care unit (aOR 1.78; 95% CI 1.19-2.67). Older adult visits were also more likely to arrive via Emergency Medical Services (EMS) (56.1% vs 34.0%; OR 2.56; 95% CI 1.89-3.46), but less likely to receive EMS-administered epinephrine (26.0% vs 32.4%; aOR 0.46; 95% CI 0.27-0.77). Visits among older adults had increased odds of anaphylaxis from medications and IV contrast, cardiovascular symptoms, and more severe outcomes, including intubation and intensive care unit admission. Improved EMS epinephrine administration and prehospital guidelines could enhance outcomes for older adults with anaphylaxis.