Validation and Use of the Anaphylaxis Score Assisting Providers (ASAP)
Monday, March 5, 2018
South Hall A2 (Convention Center)
Julie C. Brown, MDCM, MPH, Daniel Petroni, MD PhD, Chuan Zhou, PhD, Nathan Deam, MHA, Jacquelyn R Morton, MLS, Holly Clifton, MPH, Lori Rutman, MD, MPH
Rationale: Early recognition and treatment of anaphylaxis decreases morbidity and mortality, but challenges emergency providers.

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.