Methods: The Anaphylaxis Score Assisting Providers (ASAP) http://www.seattlechildrens.org/pdf/anaphylaxis-pathway.pdf (p.8) identifies patients with suspected anaphylaxis who warrant treatment with epinephrine (score ≥5). It incorporates features of existing scores, diagnostic criteria, food challenge stopping rules and care plans. Preliminary validation of the ASAP was performed retrospectively on 60 patients 0-21 years prior to clinical use. Following introduction into a clinical information system and use with standardized emergency anaphylaxis care, we evaluated score concordance with epinephrine use within 30 minutes, for patients with an ICD-based definition of anaphylaxis and/or ASAP use, evaluated in a children’s hospital urgent care (UC) or emergency department (ED).
Results: In pre-use analysis, compared with a clinical diagnosis of anaphylaxis, the ASAP demonstrated significantly better sensitivity than NIAID/FAAN criteria, 85% versus 58% (p-value = 0.002), with comparable specificity, 89% versus 93% (p-value = 0.42). In clinical use, 61 of 64 patients with an ICD-based definition of anaphylaxis received epinephrine, 20 pre-arrival (3 UC,17 ED) and 41 after arrival only (13 UC, 28 ED). Initial score and epinephrine use were concordant in 41 (93%) without pre-arrival epinephrine, and 13 (65%) with pre-arrival epinephrine. Initial score was ≥5 in 4 of 41 (10%) other patients scored (no epinephrine given). Test characteristics were: sensitivity 93% (95% confidence interval (CI) 80-98%), specificity 86% (95% CI 75-93%), positive predictive value 80% (95% CI 69-88%), negative predictive value 95% (95% CI 86%-98%).
Conclusions: The ASAP shows promise as a clinically useful anaphylaxis scoring tool.