Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Data Collection
2.2. Data Collection and Definition of the Items
2.3. Definition the Classification of Hypersensitivity Reaction
2.4. Climate and Weekday Effect Comparisons of the Two Groups
2.5. Statistical Analysis
2.6. Ethics
3. Results
3.1. Patient Enrollment and Grouping
3.1.1. Descriptive Statistics
3.1.2. Comparison of the Treatment of Both Groups
3.1.3. Comparison of Sting Reaction and Allergic Reactions in the Two Groups
3.1.4. Further Comparisons of Anaphylaxis Subgroups
3.1.5. Statistics for the Reason of Hospitalization
3.2. Climate Effect on Both Groups
3.3. Effect of Week Day on Both Groups
4. Discussion
4.1. Initial Presentation in the ED
4.1.1. Sting Lesion
4.1.2. Timeliness of ED Admission
4.1.3. ED Length of Stay and Severity of the Allergic Reaction
4.2. Clinical Management in the ED
4.2.1. Medication
4.2.2. Antibiotics and Toxoid Vaccination
4.3. Toxic and Allergic Effects of Venom
4.4. Anaphylaxis
4.4.1. Diagnosis of Anaphylaxis in the ED
4.4.2. Laboratory Tests of the Anaphylactic Groups in the ED
4.5. Disposition
4.5.1. Hospitalization
4.5.2. Mortality
4.6. Climatic and Temporal Factors
4.6.1. Temperature and Humidity Effects
4.6.2. Weekday Variations
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Type of Reaction | Total Patient n = 881 | Vespidae Group n = 538 (61.1%) | Formicidae Group n = 343, n (38.9%) | p-Value |
---|---|---|---|---|
Age (year) | 49.09 ± 17.62 | 48.81 ± 16.97 | 49.53 ± 18.61 | 0.56 |
Male—no. (%) | 503 (57.1) | 302 (56.1) | 201 (58.6) | 0.47 |
Female—no. (%) | 378(42.9) | 236 (43.9) | 142(41.4) | 0.47 |
Sting location | ||||
Upper body—no. (%) | 609 (69.1) | 515 (95.7) | 94 (27.1) | <0.01 * |
Lower body—no. (%) | 360 (39.6) | 42 (7.8) | 307 (89.2) | <0.01 * |
No. of stings | ||||
1–3 | 785 (89.1) | 503 (93.5) | 282 (82.2) | <0.01 * |
4–9 | 70 (8.0) | 23 (4.2) | 47 (13.7) | <0.01 * |
>10 | 28 (3.2) | 12 (2.2) | 16 (4.7) | 0.04 * |
Skin lesion—no. (%) | 207 (23.5) | 85 (15.8) | 122 (35.6) | <0.01 * |
Sent via ambulance—no. (%) | 36 (4.1) | 16 (3.0) | 20 (5.8) | 0.04 * |
<6 h of ED arrival—no. (%) | 589 (66.9) | 395 (73.4) | 194 (56.6) | <0.01 * |
Previous sting reaction—no. (%) | 32 (3.6) | 12 (2.0) | 21 (6.1) | 0.02 * |
Allergic history | ||||
Drugs—no. (%) | 29 (3.3) | 17 (3.2) | 12 (3.5) | 0.78 |
Food—no. (%) | 19 (2.2) | 11 (2.0) | 8 (2.3) | 0.77 a |
ED length of stay (minutes) | 90.39 ± 94.95 | 79.15 ± 92.30 | 108.00 ± 96.50 | <0.01 * |
Mortality—no. (%) | 1 (0.2) | 1 (0.4) | 0 (0.0) | 0.26 a |
Hospitalization—no. (%) | 11 (1.2) | 10 (1.9) | 1 (0.3) | 0.04 *,a |
Revisit ER—no. (%) | 12 (1.4) | 6 (1.1) | 6 (1.7) | 0.55 a |
Cellulites—no. (%) | 7 (0.8) | 3 (0.6) | 4 (1.1) | 0.32 a |
Clinical presentation on arrival | ||||
High blood pressure—no. (%) | 10 (1.1) | 6 (1.1) | 4 (1.2) | 0.95 a |
Low blood pressure—no. (%) | 29 (3.3) | 9 (1.7) | 20 (5.8) | <0.01 * |
Fever—no. (%) | 18 (2.0) | 10 (1.9) | 8 (2.3) | 0.63 a |
Dyspnea—no. (%) | 61 (6.9) | 37 (6.9) | 24 (7.0) | 0.96 |
N/V—no. (%) | 21 (2.4) | 12 (2.2) | 9 (2.6) | 0.71 a |
Loss of conscious—no. (%) | 11 (1.3) | 7 (1.3) | 4 (1.2) | 0.86 a |
Pain—no. (%) | 242 (27.5) | 201 (37.4) | 41 (12.0) | <0.01 * |
Pruritus—no. (%) | 188 (21.3) | 45 (8.4) | 143 (45.0) | <0.01 * |
Total Patients (n = 881) | Vespidae Group (n = 538) | Formicide Group (n = 343) | p-Value | |
---|---|---|---|---|
Treatment | ||||
IV or IM steroid—no. (%) | 568 (56.8) | 356 (66.2) | 212 (61.8) | 0.19 |
Oral steroid—no. (%) | 160 (18.1) | 87 (16.2) | 73 (21.3) | 0.06 |
IV or IM antihistamine—no. (%) | 583 (66.2) | 326 (60.1) | 257 (74.9) | <0.01 * |
Oral antihistamine—no. (%) | 719 (81.6) | 413 (76.8) | 306 (89.2) | <0.01 * |
Oral antibiotics—no. (%) | 20 (2.3) | 11 (2.0) | 9 (2.6) | 0.65 a |
Analgesics—no. (%) | 248 (28.1) | 205 (38.1) | 43 (12.5) | <0.01 * |
H2 blockers—no. (%) | 42 (4.8) | 25 (4.7) | 17 (5.0) | 0.83 |
Epinephrine—no. (%) | 14 (1.6) | 8 (2.2) | 6 (2.3) | 0.79 a |
Toxoid—no. (%) | 33 (3.7) | 17 (1.5) | 16 (1.8) | 0.28 |
Cold compression—no. (%) | 558 (63.4) | 356 (61.7) | 205 (59.8) | 0.06 |
Type of Reaction | All Patients (n = 881) | Vespidae Group (n = 538) | Formicidae Group (n = 343) | p-Value |
---|---|---|---|---|
LR | 666 (75.6) | 434 (80.7) | 232 (67.6) | <0.01 * |
LLR | 75 (8.5) | 36 (6.7) | 39 (11.3) | 0.02 * |
SR | 58 (6.6) | 28 (5.2) | 30 (8.8) | 0.04 * |
Anaphylaxis # | 65 (7.4) | 31 (5.8) | 34 (9.9) | 0.02 * |
Unclassified | 17 (1.9) | 9 (1.6) | 8 (2.3) | 0.488 a |
Total Anaphylaxis Patients (n = 65) | Vespidae Group with Anaphylaxis (n = 31) | Formicidae Group with Anaphylaxis (n = 34) | p-Value | |
---|---|---|---|---|
Age (year) | 53.02 ± 18.13 | 52.47 ± 16.0 | 53.53 ± 20.1 | 0.81 |
Male—no. (%) | 41 (63.1) | 19 (61.3) | 22 (64.7) | 0.78 |
Female—no. (%) | 24 (36.9) | 12 (38.7) | 12 (35.3) | 0.78 |
No. of stings | ||||
1–3—no. (%) | 17 (26.2) | 12 (38.7) | 6 (17.6) | 0.06 a |
3–9—no. (%) | 24 (36.9) | 10 (32.3) | 13 (38.2) | 0.61 |
>10—no. (%) | 24 (36.9) | 9 (29.0) | 15 (44.1) | 0.16 a |
Skin lesion—no. (%) | 29 (44.6) | 15 (48.4) | 14 (41.2) | 0.56 |
ED length of stay (minutes) | 280.60 ± 95.11 | 293.03 ± 82.96 | 269.26 ± 104.92 | 0.35 |
Sent via ambulance—no. (%) | 30 (46.1) | 12 (36.3) | 18 (56.3) | 0.10 |
<6 h of ED arrival—no. (%) | 50 (76.9) | 25 (80.6) | 25 (73.5) | 0.50 |
Previous sting reaction—no. (%) | 9 (13.8) | 3 (9.6) | 8 (23.5) | <0.01 *,a |
Mortality—no. (%) | 1 (1.5) | 1 (3.2) | 0 (0.0) | 0.48 a |
Hospitalization—no. (%) | 11 (16.9) | 10 (32.3) | 1 (2.9) | <0.01 *,a |
Laboratory data | ||||
WBC (μL) | 9553.55 ± 3708.12 | 10,273.55 ± 4188.09 | 8897.09 ± 3128.96 | 0.14 |
Hemoglobin (g/dL) | 14.79 ± 1.63 | 14.66 ± 1.58 | 14.91 ± 1.69 | 0.55 |
Platelets (μL) | 259,843.08 ± 107,126.89 | 272,580.65 ± 138,483.88 | 248,229.41 ± 67,313.36 | 0.36 |
AST (mg/dL) | 40.76 ± 138.68 | 64.68 ± 199.56 | 19.33 ± 10.12 | 0.22 |
ALT (mg/dL) | 43.03 ± 152.19 | 64.68 ± 219.54 | 23.29 ± 16.06 | 0.28 |
Serum creatinine (mg/dL) | 1.05 ± 0.36 | 1.13 ± 0.45 | 0.97 ± 0.24 | 0.09 |
Sodium (mg/dL) | 136.83 ± 3.79 | 136.52 ± 1.96 | 137.12 ± 4.92 | 0.53 |
Potassium (mg/dL) | 3.63 ± 0.46 | 3.62 ± 0.42 | 3.66 ± 0.50 | 0.70 |
Creatine Kinase (U/L) | 265.95 ± 703.57 | 457.65 ± 991.54 | 91.18 ± 15.76 | 0.05 * |
CRP (mg/dL) | 0.28 ± 0.37 | 0.35 ± 0.48 | 0.18 ± 0.13 | 0.06 |
Total Patients (n = 11) | Vespidae group (n = 10) | Formicidae Group (n = 1) | |
---|---|---|---|
Acute coronary syndrome | 3 | 3 (2MI) | 0 |
Ischemic Stroke | 1 | 0 | 1 |
Rhabdomyolysis | 2 | 2 | 0 |
Acute renal failure | 2 | 2 | 0 |
MODS § | 2 | 2 | 0 |
Unsubsidized allergy | 1 | 1 | 0 |
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Lin, Y.-Y.; Chiu, C.-C.; Chang, H.-A.; Kao, Y.-H.; Hsiao, P.-J.; Chuu, C.-P. Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan. Int. J. Environ. Res. Public Health 2020, 17, 6162. https://doi.org/10.3390/ijerph17176162
Lin Y-Y, Chiu C-C, Chang H-A, Kao Y-H, Hsiao P-J, Chuu C-P. Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan. International Journal of Environmental Research and Public Health. 2020; 17(17):6162. https://doi.org/10.3390/ijerph17176162
Chicago/Turabian StyleLin, Yen-Yue, Chih-Chien Chiu, Hsin-An Chang, Yung-Hsi Kao, Po-Jen Hsiao, and Chih-Pin Chuu. 2020. "Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan" International Journal of Environmental Research and Public Health 17, no. 17: 6162. https://doi.org/10.3390/ijerph17176162