Brown identified risk factors for hypotension in a patient experiencing a generalized hypersensitivity reaction. These can help identify a patient who may require more aggressive management. The author is from Royal Hobart Hospital in Australia.
Patient-specific factors associated with an increased risk for hypotension:
(1) age >= 40 years
Features of a hypersensitivity reaction associated with hypotension:
(1) incontinence
(2) collapse or loss of consciousness
(3) diaphoresis (sweating)
(4) cyanosis or decreased oxygen saturation (<= 92% on room air)
(5) vomiting
(6) dizziness
(7) dyspnea
(8) nausea
where:
• Incontinence, collapse and cyanosis/(decreased oxygen saturation) are markers of a severe reaction, while the other 5 factors are associated with a moderate reaction.
• The odds ratio for incontinence is 13. The odds ratios for the other factors range from 2.1 to 3.8
• Cardiovascular comorbidities, ACE inhibitors, and beta blockers were not found to be associated with severe reactions or death in multivariate analysis.
For the implementation I have tried the following scheme to capture this information.
|
Parameter |
Finding |
Points |
|
incontinence |
present |
2 |
|
|
absent |
0 |
|
age of the patient |
>= 40 |
1 |
|
|
< 40 |
0 |
|
collapse or loss of consciousness |
present |
1 |
|
|
absent |
0 |
|
diaphoresis |
present |
1 |
|
|
absent |
0 |
|
cyanosis or decreased oxygen saturation |
present |
1 |
|
|
absent |
0 |
|
vomiting |
present |
1 |
|
|
absent |
0 |
|
dizziness |
present |
1 |
|
|
absent |
0 |
|
dyspnea |
present |
1 |
|
|
absent |
0 |
|
nausea |
present |
1 |
|
|
absent |
0 |
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
|
Total Score |
Risk of Hypoxia |
|
0 |
low |
|
1 |
low to moderate |
|
2 |
moderate to high |
|
3 |
high |
|
4 - 10 |
very high |
Specialty: Immunology/Rheumatology
ICD-10: ,
