{
  "abstract": "BACKGROUND:: The 2023 US Anaphylaxis Practice Parameter indicated that some patients receiving epinephrine in the community might avoid emergency department (ED) visits; however, the criteria and safety of this approach remain unproven.\n\nOBJECTIVE:: To derive and validate a clinical prediction model for identifying children at risk of receiving epinephrine after arriving at the ED.\n\nMETHODS:: We conducted a 31-center retrospective cohort study of children aged 6 months to less than 18 years who received 1 prehospital dose of epinephrine for allergic reactions between 2016 and 2019. The outcome was receipt of epinephrine after ED arrival. We used least absolute shrinkage and selection operator regression to derive the model in 70% of the patients to identify prehospital factors associated with epinephrine administration. Internal and external validations included 20% and 10% of the cohort, respectively.\n\nRESULTS:: The 2318 eligible patients had a median age of 8.4 years (interquartile range, 3.8–13.4), and 15.7% (n = 364) received epinephrine after ED arrival. Prehospital factors associated with the receipt of additional epinephrine included a history of asthma, cardiovascular symptoms before epinephrine, persistent symptoms after epinephrine, and any new/recurrent respiratory, cardiovascular, gastrointestinal, or nonspecific symptoms after epinephrine. In the external validation, 30% (65 of 216) of encounters were classified as low risk. The presence of any risk factor had a sensitivity of 0.93 (95% CI, 0.80–0.98), specificity of 0.35 (95% CI, 0.28–0.43), positive predictive value of 0.25 (95% CI, 0.18–0.33), and negative predictive value of 0.95 (95% CI, 0.87–0.99) for identifying patients who received epinephrine after ED arrival.\n\nCONCLUSIONS:: We developed and validated a clinical prediction model to identify children treated with a single prehospital dose of epinephrine who may not require ED care. Implementation of the model could reduce avoidable ED visits for children with anaphylaxis.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio",
    "Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY",
    "Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio",
    "Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio",
    "Departments of Pediatrics and Emergency Medicine, Division of Pediatric Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada",
    "Division of Emergency Medicine, Boston Children’s Hospital, Boston, Mass",
    "Department of Pediatrics, Nemours Children’s Health Delaware, Wilmington, Del",
    "Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Conn",
    "Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, NY",
    "Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis",
    "University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, Colo",
    "University of Texas-McGovern Medical School, Houston, Tex",
    "Department of Emergency Medicine, University of Minnesota, St. Paul and Minneapolis, Minn",
    "Department of Pediatrics, UT Southwestern, Dallas, Tex",
    "Department of Pediatrics, Division of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, Tex",
    "Department of Emergency Medicine and Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vt",
    "Department of Pediatrics, Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, St. Petersburg, Fla",
    "Division of Pediatric Emergency Medicine, UT Southwestern Medical Center / Children’s Medical Center, Dallas, Tex",
    "Department of Pediatrics, Division of Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, SC",
    "Rady Children’s Hospital, University of California San Diego, San Diego, Calif",
    "Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY",
    "Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Philadelphia, Pa",
    "Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah",
    "Division of Emergency Medicine and Transport, Los Angeles, Calif",
    "The Children’s Hospital at Oklahoma University Health, Oklahoma City, Okla",
    "Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Stanford University, Palo Alto, Calif",
    "Pediatric Emergency Medicine, University of Mississippi Medical Center, Jackson, Miss",
    "Department of Pediatrics at Children’s Mercy Kansas City, Kansas City, Mo",
    "The Johns Hopkins School of Medicine, Department of Pediatrics, Baltimore, Md",
    "Department of Emergency Medicine, Massachusetts General Brigham for Children, Harvard Medical School, Boston, Mass",
    "Department of Pediatric Emergency Medicine, Children’s Minnesota, St. Paul and Minneapolis, Minn",
    "Division of Emergency Medicine, Ann & Robert Lurie Children’s Hospital, Chicago, Ill"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 40,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Timothy E. Dribin"
    },
    {
      "affs": [
        0
      ],
      "name": "David Schnadower"
    },
    {
      "affs": [
        1
      ],
      "name": "Hugh A. Sampson"
    },
    {
      "affs": [
        2
      ],
      "name": "Yin Zhang"
    },
    {
      "affs": [
        3
      ],
      "name": "Nanhua Zhang"
    },
    {
      "affs": [
        4
      ],
      "name": "Stephen B. Freedman"
    },
    {
      "affs": [
        5
      ],
      "name": "Mark I. Neuman"
    },
    {
      "affs": [
        6
      ],
      "name": "David C. Brousseau"
    },
    {
      "affs": [
        7
      ],
      "name": "Rakesh D. Mistry"
    },
    {
      "affs": [
        0
      ],
      "name": "Stephanie Boyd"
    },
    {
      "affs": [
        8
      ],
      "name": "Yonatan Wolnerman"
    },
    {
      "affs": [
        9
      ],
      "name": "Patrick S. Walsh"
    },
    {
      "affs": [
        10
      ],
      "name": "Craig Vander Wyst"
    },
    {
      "affs": [
        11
      ],
      "name": "Vandana Thapar"
    },
    {
      "affs": [
        12
      ],
      "name": "Jonathan Strutt"
    },
    {
      "affs": [
        13
      ],
      "name": "Geetanjali Srivastava"
    },
    {
      "affs": [
        14
      ],
      "name": "Nidhi V. Singh"
    },
    {
      "affs": [
        6
      ],
      "name": "Christopher J. Russo"
    },
    {
      "affs": [
        15
      ],
      "name": "Christian D. Pulcini"
    },
    {
      "affs": [
        16
      ],
      "name": "Thuy L. Ngo"
    },
    {
      "affs": [
        17
      ],
      "name": "Jo-Ann O. Nesiama"
    },
    {
      "affs": [
        18
      ],
      "name": "Matthew M. Moake"
    },
    {
      "affs": [
        19
      ],
      "name": "Ashley M. Metcalf"
    },
    {
      "affs": [
        20
      ],
      "name": "Tamar R. Lubell"
    },
    {
      "affs": [
        21
      ],
      "name": "Juhee Lee"
    },
    {
      "affs": [
        22
      ],
      "name": "Chari D. Larsen"
    },
    {
      "affs": [
        23
      ],
      "name": "Karen Y. Kwan"
    },
    {
      "affs": [
        24
      ],
      "name": "Curtis L. Knoles"
    },
    {
      "affs": [
        25
      ],
      "name": "Kajal Khanna"
    },
    {
      "affs": [
        10
      ],
      "name": "Julia F. Freeman"
    },
    {
      "affs": [
        26
      ],
      "name": "Justin R. Davis"
    },
    {
      "affs": [
        27
      ],
      "name": "Alicia Daggett"
    },
    {
      "affs": [
        28
      ],
      "name": "Joanna S. Cohen"
    },
    {
      "affs": [
        29
      ],
      "name": "Ari R. Cohen"
    },
    {
      "affs": [
        29
      ],
      "name": "Wee-Jhong Chua"
    },
    {
      "affs": [
        9
      ],
      "name": "Sri S. Chinta"
    },
    {
      "affs": [
        25
      ],
      "name": "Brittany Boswell"
    },
    {
      "affs": [
        30
      ],
      "name": "Kelly R. Bergmann"
    },
    {
      "affs": [
        7
      ],
      "name": "Paul L. Aronson"
    },
    {
      "affs": [
        31
      ],
      "name": "Kenneth A. Michelson"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fa3mzz4zj56v0.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jaip.2026.06.021",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13730628/?tool=EBI",
  "id": "fa3mzz4zj56v0",
  "issns": [
    "2213-2198",
    "2213-2201"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13730628",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Article"
    ],
    [
      "openalex",
      "2723|Food Allergy and Anaphylaxis Research"
    ]
  ],
  "openalex": "W7165788266",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13730628/pdf/?tool=EBI",
  "pmcid": "PMC13730628",
  "pmid": "42342031",
  "published": "2026-06-24",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/fa3mzz4zj56v0.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T15:20:47Z",
      "native_id": "PMC:PMC13730628",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13730628"
    },
    {
      "first_seen": "2026-11-07T12:23:08Z",
      "native_id": "PMC13730628",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.jaip.2026.06.021"
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  "subjects": [
    {
      "field": "biology",
      "origin": "openalex:2723|Food Allergy and Anaphylaxis Research",
      "subfield": "immunology"
    }
  ],
  "title": "Prediction Model for Children With Anaphylaxis Who May Not Require Emergency Department Care: A Multicenter Retrospective Cohort Study",
  "title_text": "Prediction Model for Children With Anaphylaxis Who May Not Require Emergency Department Care: A Multicenter Retrospective Cohort Study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:23:08Z",
  "url": "https://research.draconitic.com/paper/fa3mzz4zj56v0",
  "venue": "The Journal of Allergy and Clinical Immunology. in Practice",
  "versions": []
}