2.1 Development of triggers for Anaphylaxis
ADR reports in our hospital from January 2014 to December 2021 were
exported from the National Adverse Drug Reaction Monitoring System and
retrospectively reviewed by a pharmacist and an allergist. Referring to
the diagnostic criteria for anaphylaxis [1](Table 1) and the
Technical Specifications and Evaluation Criteria for Common Serious
Adverse Drug Reactions issued by the National Center for ADR, China,
reviewers identified anaphylaxis cases and filled in the electronic case
report forms, including diagnoses, department, characteristic medical
orders, and progress notes,etal. Relevant data were analyzed and initial
entries of triggers were formulated. An expert consultation
questionnaire was designed according to the initial entries. The
questionnaire comprises two parts, the first part was the basic
information of experts, including major, education background, working
years, professional title, etc. The second part was the evaluation of
experts on the importance, familiarity, and judgment basis of trigger
entries. We convened an 8-member multidisciplinary panel of experts
involving one each of allergists, dermatologists, emergency specialists,
cardiologists, intensivists, respiratory physicians, neurologists, and
pharmacists, all members had rich experience in the diagnosis and
treatment of anaphylaxis. All experts were asked to rate the importance
and familiarity of each item on a 5-point Likert scale (with 1 meaning
strongly disagree, 2 meaning agree, 3 meaning neutral, 4 meaning agree,
and 5 indicating strongly agree). The judgment basis has 4 levels:
theoretical analysis, practice, informed by domestic and foreign peers,
and intuition. A score of 0.1-0.5 points was given according to the
degree of influence on expert judgment. The highest score of 0.5 was
obtained when the practice had a significant impact on expert judgment.
Additionally, panel members were encouraged to submit free-text comments
to clarify their responses to every question, suggest additional
questions, or recommend modifications to exist questions. The indicators
of the Delphi method include the positive coefficient of experts, the
degree of expert authority, the degree of expert opinion concentration,
and the degree of expert opinion coordination[14]. The expert
positivity coefficient was expressed as the questionnaire recovery rate.
The authority coefficient of experts (Cr) was determined by the judgment
basis of the entries (Ca) and familiarity with the consultation content
(Cs), where Cr = (Ca + Cs)/2, and Cr ≥ 0.7 was generally considered to
be highly credible. The degree of expert opinion concentration was
expressed by the mean value of importance score (Mj) and full score
frequency (Kj) of trigger entries. The cut-off value of Mj and Kj = mean
- standard deviation, and those with scores higher than the cut-off
value were included. The degree of expert opinion coordination was
expressed as the coefficient of variation (Vj). The cut-off value of Vj
= mean + standard deviation and those with scores lower than the cut-off
value were included. Entries that did not meet any of the three criteria
were eliminated [15].