Anaesthesia · 2025
Penicillin allergy risk stratification tool for use by non-allergists in the peri-operative setting: an agreement study and qualitative process evaluation.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Dias Priyanthi, Walshaw Emma, Flatau Sam, O'Grady Eileen, Hopkins Philip M, Garvey Lene Heise, Littlejohns Anna, Rousseau Nikki, Pearse Rupert M, Shinkins Bethany, Savic Louise
Аннотация
INTRODUCTION: Many patients are labelled incorrectly as 'penicillin allergic'. This label is associated with poor health outcomes, regardless of whether the allergy is genuine. We designed a study to assess agreement between allergy specialists (consultant allergists or immunologists) and non-allergists when using a risk stratification tool to determine suitability for a penicillin challenge test.
METHODS: In this two-centre mixed-method study, adult patients undergoing surgery who had been labelled penicillin allergic were assessed by a healthcare professional with no formal allergy training (consultant anaesthetist or peri-operative nurse) and an allergy specialist doctor using the risk stratification tool. Cohen's kappa was used to quantify agreement. We conducted a qualitative process evaluation based on individual and group interviews to explore user experience.
RESULTS: We recruited 139 patients and 11 healthcare professionals; 101 patients completed both assessments (median (IQR [range]) age was 53 (40-66 [19-86]) y, 71% women). Allergist and non-allergist assessments agreed for 63 (62%) patients. In the remaining 38 (38%), most disagreements represented an overcautious approach by non-allergists, except in seven patients categorised as unsuitable (or uncertain) by the allergist but suitable by the non-allergist. Inter-rater agreement was moderate (unweighted κ 0.43, 95%CI 0.30-0.57; weighted κ 0.47, 95%CI 0.27-0.67). The prevalence and bias-adjusted score indicated poor inter-rater reliability (κ score 0.25, 95%CI 0.06-0.44). Qualitative analysis indicated low confidence in the tool among non-allergists, with a perceived need for allergy training and specialist support.
DISCUSSION: This penicillin allergy risk stratification tool, designed for use by healthcare professionals with no formal allergy training, showed poor agreement with allergy expert assessments.
METHODS: In this two-centre mixed-method study, adult patients undergoing surgery who had been labelled penicillin allergic were assessed by a healthcare professional with no formal allergy training (consultant anaesthetist or peri-operative nurse) and an allergy specialist doctor using the risk stratification tool. Cohen's kappa was used to quantify agreement. We conducted a qualitative process evaluation based on individual and group interviews to explore user experience.
RESULTS: We recruited 139 patients and 11 healthcare professionals; 101 patients completed both assessments (median (IQR [range]) age was 53 (40-66 [19-86]) y, 71% women). Allergist and non-allergist assessments agreed for 63 (62%) patients. In the remaining 38 (38%), most disagreements represented an overcautious approach by non-allergists, except in seven patients categorised as unsuitable (or uncertain) by the allergist but suitable by the non-allergist. Inter-rater agreement was moderate (unweighted κ 0.43, 95%CI 0.30-0.57; weighted κ 0.47, 95%CI 0.27-0.67). The prevalence and bias-adjusted score indicated poor inter-rater reliability (κ score 0.25, 95%CI 0.06-0.44). Qualitative analysis indicated low confidence in the tool among non-allergists, with a perceived need for allergy training and specialist support.
DISCUSSION: This penicillin allergy risk stratification tool, designed for use by healthcare professionals with no formal allergy training, showed poor agreement with allergy expert assessments.