Incidence of Fatal Anaphylaxis: A Systematic Review of Observational Studies.

BACKGROUND: Fatal anaphylaxis is very rare, with an incidence ranging from 0.5 to 1 deaths per million person-years. OBJECTIVE: Based on a systematic review, we aimed to explain differences in the reported incidence of fatal anaphylaxis based on the methodological and demographic factors addressed in the various studies. METHODS: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for relevant retrospective and prospective cohort studies and registry studies that had assessed the anaphylaxis mortality rate for the population of a country or for an administrative region. The research strategy was based on combining the term "anaphylaxis" with "death", "study design", and "main outcomes" (incidence). RESULTS: A total of 46 studies met the study criteria and included 16,541 deaths. The range of the anaphylaxis mortality rate for all causes of anaphylaxis was 0.002-2.51 deaths per million person-years. Fatal anaphylaxis due to food (range 0.002-0.29) was rarer than deaths due to drugs (range 0.004-0.56) or Hymenoptera venom (range 0.02-0.61). The frequency of deaths due to anaphylaxis by drugs increased during the study period (IRR per year, 1.02; 95%CI, 1.00-1.04). We detected considerable heterogeneity in almost all of the meta-analyses carried out. CONCLUSION: The incidence of fatal anaphylaxis is very low and differs according to the various subgroups analyzed. The studies were very heterogeneous. Fatal anaphylaxis due to food seems to be less common than fatal anaphylaxis due to drugs or Hymenoptera venom.

Incidence of Fatal Anaphylaxis A Systematic Review of Observational Studies

Background: Fatal anaphylaxis is very rare, with an incidence ranging from 0.5 to 1 deaths per million person-years. Objective: Based on a systematic review, we aimed to explain differences in the reported incidence of fatal anaphylaxis based on the methodological and demographic factors addressed in the various studies. Methods: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for relevant retrospective and prospective cohort studies and registry studies that had assessed the anaphylaxis mortality rate for the population of a country or for an administrative region. The research strategy was based on combining the term “anaphylaxis” with “death”, “study design”, and “main outcomes” (incidence). Results: A total of 46 studies met the study criteria and included 16,541 deaths. The range of the anaphylaxis mortality rate for all causes of anaphylaxis was 0.002-2.51 deaths per million person-years. Fatal anaphylaxis due to food (range 0.002-0.29) was rarer than deaths due to drugs (range 0.004-0.56) or Hymenoptera venom (range 0.02-0.61). The frequency of deaths due to anaphylaxis by drugs increased during the study period (IRR per year, 1.02; 95%CI, 1.00-1.04). We detected considerable heterogeneity in almost all of the meta-analyses carried out. Conclusion: The incidence of fatal anaphylaxis is very low and differs according to the various subgroups analyzed. The studies were very heterogeneous. Fatal anaphylaxis due to food seems to be less common than fatal anaphylaxis due to drugs or Hymenoptera venom (AU)

Antecedentes: La muerte por anafilaxia es un evento muy excepcional, con una incidencia que varía de 0,5 a 1 muerte por millón de personas/año. Objetivo: Usando las técnicas de una revisión sistemática, nuestro objetivo ha sido explicar las diferencias en la incidencia informada de la muerte por anafilaxia atendiendo a diversos factores metodológicos y demográficos empleados en los diversos estudios de la revisión. Métodos: Se realizaron búsquedas en PubMed/MEDLINE, EMBASE y Web of Science, con el fin de obtener estudios de cohortes y registros prospectivos y retrospectivos relevantes que hubieran evaluado la tasa de muerte por anafilaxia en la población de un país o una región administrativa. La estrategia de investigación se basó en combinar “anafilaxia” con “muerte”, “diseño del estudio” y “resultados principales” (incidencia). Resultados: Un total de 46 estudios cumplieron con los criterios del estudio. Los estudios incluyeron 16.541 muertes. El rango de la tasa de mortalidad por anafilaxia para todas las causas de anafilaxia fue de 0,002 a 2,51 muertes por millón de personas/año. La anafilaxia mortal debida a los alimentos (rango 0,002-0,29) fue más rara que las muertes debidas a medicamentos (rango 0,004-0,56) o veneno de himenópteros (rango 0,02-0,61). La frecuencia de muertes por anafilaxia por fármacos aumentó durante el período de estudio (IRR por año, 1,02; IC del 95%: 1,00-1,04). Se detectó una heterogeneidad considerable en casi todos los metaanálisis realizados. Conclusión: La incidencia de anafilaxia mortal es muy baja y difiere según los distintos subgrupos analizados. Los estudios fueron muy heterogéneos. La muerte por anafilaxia debida a alimentos parece ser menos común que la anafilaxia mortal debida a fármacos o por veneno de himenópteros (AU)

Design, Planning and Management of the Hospital Custody Unit at Hospital Universitario Fundación Alcorcón.

OBJECTIVE: The design and management of a Hospital Custody Unit at Hospital Universitario Fundación Alcorcón, to focus the aim of this study on specialized medical care for extra-penitentiary patients who have suffered from a disease. We are building a new space to facilitate their daily lives at hospital and we want to offer a double function to the patients that consists of a custody space and a health rehabilitation space. MATERIAL AND METHODS: We carried out a scientific literature search on the international and national databases, about Hospital Custody Units or Restricted Access Units. The language of the reviews that we checked was English and Spanish. RESULTS: We wrote the Action Guide of the Hospital Custody Unit for the design, planning and management of the Hospital Custody Unit at Hospital Universitario Fundación Alcorcón. (We included complementary bibliographic material and the Quick Guide in the Unit). DISCUSSION: The Hospital Custody Unit will be compatible with medical activity, occupational safety and the custody of patients that are in prison. We thus require consensus with police departments about custody protocols along with assistance from the clinicians' teams at penitentiary centers and referral hospitals. Furthermore, it is important to step up special care for mental health and to promote telemedicine and new technologies to streamline medical care along with coordination with healthcare professionals.

Diseño, planificación y organización de la Unidad de Custodia Hospitalaria del Hospital Universitario Fundación Alcorcón / Design, planning and management of the hospital custody unit at Hospital Universitario Fundación Alcorcón

Objetivo: Diseñar y organizar la Unidad de Custodia Hospitalaria (UCH) en el Hospital Universitario Fundación Alcorcón (HUFA), adecuada a los objetivos para la atención sanitaria especializada extrapenitenciaria de los internos que sufren una enfermedad, creando un entorno que facilita la vida diaria asistencial en el hospital y que responde a la doble función de lugar de custodia y espacio favorecedor de la rehabilitación de la salud. Material y método: Se realizó una búsqueda en la literatura científica en las bases de datos internacionales, así como nacionales sobre unidades de acceso restringido O unidades de custodia. Resultados: Diseño, planificación y organización de la Unidad de Custodia Hospitalaria del HUFA. Realización del Protocolo de Actuación de la Unidad de Custodia Hospitalaria del HUFA así como la Guía Rápida de Actuación para dicha Unidad. Discusión: La UCH va a permitir compatibilizar la actividad asistencial, la seguridad de los profesionales y la custodia de los pacientes privados de libertad. Para ello se requiere consensuar protocolos con los Cuerpos y Fuerzas de Seguridad del Estado y de asistencia entre los equipos sanitarios de los centros penitenciarios y del hospital de referencia, así como reforzar los cuidados especializados en salud mental e impulsar la telemedicina y las nuevas tecnologías para agilizar y acercar la prestación sanitaria y coordinar eficazmente el trabajo de los profesionales (AU)

Objective: The design and management of a Hospital Custody Unit at Hospital Universitario Fundación Alcorcón, to focus the aim of this study on specialized medical care for extra-penitentiary patients who have suffered from a disease. We are building a new space to facilitate their daily lives at hospital and we want to offer a double function to the patients that consists of a custody space and a health rehabilitation space. Material and methods: We carried out a scientific literature search on the international and national databases, about Hospital Custody Units or Restricted Access Units. The language of the reviews that we checked was English and Spanish. Results: We wrote the Action Guide of the Hospital Custody Unit for the design, planning and management of the Hospital Custody Unit at Hospital Universitario Fundación Alcorcón. (We included complementary bibliographic material and the Quick Guide in the Unit). Discussion: The Hospital Custody Unit will be compatible with medical activity, occupational safety and the custody of patients that are in prison. We thus require consensus with police departments about custody protocols along with assistance from the clinicians’ teams at penitentiary centers and referral hospitals. Furthermore, it is important to step up special care for mental health and to promote telemedicine and new technologies to streamline medical care along with coordination with healthcare professionals (AU)

Abordaje en el cribado de cáncer mamario en grupos poblacionales de riesgo elevado / Breast cancer screening in high risk populations

El objetivo de este trabajo es definir qué pacientes integran los grupos de riesgo alto e intermedio de padecer cáncer mamario, hacer una revisión de los estudios de cribado con resonancia magnética añadida a mamografía en pacientes de alto riesgo (y describir las características de imagen de los cánceres en este grupo), revisar los estudios con resonancia magnética realizados en subgrupos de riesgo intermedio, y realizar una actualización en recomendaciones en el cribado en pacientes con riesgo alto e intermedio (basada en las recomendaciones recientes de las principales sociedades/guías americanas y europeas)(AU)

We aim to define which patients make up the populations with high and intermediate risk of developing breast cancer, to review the studies of screening with magnetic resonance imaging in addition to mammography in high risk patients (describing the imaging characteristics of the cancers in this group), to review the studies of screening with magnetic resonance imaging in patients with intermediate risk, and to update the guidelines for screening in patients with high or intermediate risk (based on the recent recommendations of the main scientific societies/American and European guidelines)(AU)

[Breast cancer screening in high risk populations]. / Abordaje en el cribado de cáncer mamario en grupos poblacionales de riesgo elevado.

We aim to define which patients make up the populations with high and intermediate risk of developing breast cancer, to review the studies of screening with magnetic resonance imaging in addition to mammography in high risk patients (describing the imaging characteristics of the cancers in this group), to review the studies of screening with magnetic resonance imaging in patients with intermediate risk, and to update the guidelines for screening in patients with high or intermediate risk (based on the recent recommendations of the main scientific societies/American and European guidelines).