BACKGROUND & AIMS: :Practices for planned birth among women with low-risk pregnancies vary by birth setting, medical professional, and organizational system. Appropriate monitoring is essential for quality improvement. Although sets of quality indicators have been developed, their applicability has not been tested. To improve the quality of childbirth care for low-risk mothers and infants in Japanese hospitals, we developed 35 quality indicators using existing clinical guidelines and quality indicators. We retrospectively analysed data for 347 women in Japan diagnosed with low-risk pregnancy in the second trimester, admitted between April 2015 and March 2016. We obtained scores for 35 quality indicators and evaluated their applicability, i.e., feasibility, improvement potential, and reliability (intra- and inter-rater reliability: kappa score, positive and negative agreement). The range of adherence to each indicator was 0-95.7%. We identified feasibility concerns for six indicators with over 25% missing data. Two indicators with over 90% adherence showed limited potential for improvement. Three indicators had poor kappa scores for intra-rater reliability, with positive/negative agreement scores 0.94/0.33, 0.33/0.95, and 0.00/0.97, respectively. Two indicators had poor kappa scores for inter-rater reliability, with positive/negative agreement scores 0.25/0.92 and 0.68/0.61, respectively. The findings indicated that these 35 care quality indicators for low-risk pregnant women may be applicable to real-world practice, with some caveats.

背景与目标： : 低风险怀孕妇女的计划生育做法因出生环境，医疗专业人员和组织系统而异。适当的监控对于质量改进至关重要。尽管已经开发了质量指标集，但尚未对其适用性进行测试。为了提高日本医院低危母婴的分娩护理质量，我们使用现有的临床指南和质量指标制定了35项质量指标。我们回顾性分析了日本347名在2015年4月和2016年3月之间被诊断为妊娠中期低风险妊娠的妇女的数据。我们获得了35个质量指标的分数，并评估了它们的适用性，即可行性、改进潜力和可靠性 (评分者内和评分者间的可靠性: kappa评分，积极和消极一致)。每个指标的依从性范围为0-95.7%。我们确定了六个指标的可行性问题，其中有25% 多个数据缺失。遵守超过90% 的两个指标显示出有限的改进潜力。三个指标的评分员内信度kappa评分较差，阳性/阴性一致性得分分别为0.94/0.33，0.33/0.95和0.00/0.97。两个指标的评分员间信度kappa评分较差，阳性/阴性一致性得分分别为0.25/0.92和0.68/0.61。研究结果表明，低风险孕妇的这35项护理质量指标可能适用于现实世界，但有一些警告。

BACKGROUND & AIMS: BACKGROUND:Detecting bacteremia among surgical in-patients is more obscure than other patients due to the inflammatory condition caused by the surgery. The previous criteria such as systemic inflammatory response syndrome or Sepsis-3 are not available for use in general wards, and thus, many clinicians usually rely on practical senses to diagnose postoperative infection. OBJECTIVE:This study aims to evaluate the performance of continuous monitoring with a deep learning model for early detection of bacteremia for surgical in-patients in the general ward and the intensive care unit (ICU). METHODS:In this retrospective cohort study, we included 36,023 consecutive patients who underwent general surgery between October and December 2017 at a tertiary referral hospital in South Korea. The primary outcome was the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC) for detecting bacteremia by the deep learning model, and the secondary outcome was the feature explainability of the model by occlusion analysis. RESULTS:Out of the 36,023 patients in the data set, 720 cases of bacteremia were included. Our deep learning-based model showed an AUROC of 0.97 (95% CI 0.974-0.981) and an AUPRC of 0.17 (95% CI 0.147-0.203) for detecting bacteremia in surgical in-patients. For predicting bacteremia within the previous 24-hour period, the AUROC and AUPRC values were 0.93 and 0.15, respectively. Occlusion analysis showed that vital signs and laboratory measurements (eg, kidney function test and white blood cell group) were the most important variables for detecting bacteremia. CONCLUSIONS:A deep learning model based on time series electronic health records data had a high detective ability for bacteremia for surgical in-patients in the general ward and the ICU. The model may be able to assist clinicians in evaluating infection among in-patients, ordering blood cultures, and prescribing antibiotics with real-time monitoring.

背景与目标：

BACKGROUND & AIMS: AIM:To explore health-care professionals' documentation of patient wellbeing in the first five months after open heart surgery. BACKGROUND:Open heart surgery (coronary artery bypass grafting or heart valve replacement) is an intervention aimed at relief of symptoms and increased wellbeing. It is a complex procedure with deep experiences encompassing physiological, psychological and social aspects. Health-care professionals' documentation of expressions of decreased wellbeing related to open heart surgery is an important basis for decisions and for the understanding of patients' overall health situation. METHOD:Eighty medical records were examined by means of qualitative and quantitative methods in order to explore documentation of patient wellbeing at four points in time. The analysis was performed by content analysis and descriptive statistics. RESULTS:Documentation of physical wellbeing was dominant on all occasions, while psychological wellbeing was moderately well documented and social aspects of wellbeing were rarely documented. CONCLUSION:The medical records did not adequately reflect the complexity of undergoing open heart surgery. Hence the holistic approach was not confirmed in health-care professionals' documentation. IMPLICATIONS FOR NURSING MANAGEMENT:Managers need to support and work for a patient-centred approach in cardiac care, resulting in patient documentation that reflects patient wellbeing as a whole.

背景与目标：

BACKGROUND & AIMS: :While electronic health records have emerged as promising tools to help improve quality of care, nursing homes have lagged behind in implementation. This study assessed electronic health records implementation, associated facility characteristics, and potential impact on quality indicators in nursing homes. Using national Centers for Medicare & Medicaid Services and survey data for nursing homes, a cross-sectional analysis was conducted to identify variations between nursing homes that had and had not implemented electronic health records. A difference-in-differences analysis was used to estimate the longitudinal effect of electronic health records on commonly used quality indicators. Data from 927 nursing homes were examined, 49.1% of which had implemented electronic health records. Nursing homes with electronic health records were more likely to be nonprofit/government owned (P = .04) and had a lower percentage of Medicaid residents (P = .02) and higher certified nursing assistant and registered nurse staffing levels (P = .002 and .02, respectively). Difference-in-differences analysis showed greater quality improvements after implementation for five long-stay and two short-stay quality measures (P = .001 and .01, respectively) compared with those who did not implement electronic health records. Implementation rates in nursing homes are low compared with other settings, and better-resourced facilities are more likely to have implemented electronic health records. Consistent with other settings, electronic health records implementation improves quality in nursing homes, but further research is needed to better understand the mechanism for improvement and how it can best be supported.

背景与目标： : 尽管电子健康记录已成为帮助提高护理质量的有希望的工具，但养老院的实施却落后了。这项研究评估了电子健康记录的实施情况，相关设施的特征以及对疗养院质量指标的潜在影响。使用国家医疗保险和医疗补助服务中心和疗养院的调查数据，进行了横断面分析，以确定已经实施和未实施电子健康记录的疗养院之间的差异。采用差异内差分析估计电子健康档案对常用质量指标的纵向影响。检查了927家疗养院的数据，其中49.1% 家已经实施了电子健康记录。拥有电子健康记录的疗养院更有可能是非营利组织/政府所有 (P = .04)，医疗补助居民比例较低 (P = .02)，认证护理助理和注册护士人员配备水平较高 (P = 0.002和0.02)。差异分析显示，与未实施电子健康记录的人相比，实施了五项长期停留和两项短期停留质量指标 (分别为P = .001和.01) 后，质量得到了更大的改善。与其他环境相比，疗养院的实施率较低，资源更充足的设施更有可能实施电子健康记录。与其他设置一致，电子健康记录的实施提高了疗养院的质量，但需要进一步研究以更好地了解改进机制以及如何最好地支持它。

BACKGROUND & AIMS: :The Vanderbilt DNA repository, BioVU, links DNA from leftover clinical blood samples to de-identified electronic medical records (EMRs). After initiating adult sample collection, pediatric extension required consideration of ethical concerns specific to pediatrics and implementation of specialized DNA extraction methods. In the first year of pediatric sample collection, more than 11,000 samples from individuals younger than 18 years were included. We compared data from the pediatric BioVU cohort with those from the overall Vanderbilt University Medical Center pediatric population and found similar demographic characteristics; however, the BioVU cohort had higher rates of select diseases, medication exposures, and laboratory testing, demonstrating enriched representation of severe or chronic disease. The fact that the sample accumulation is not balanced may accelerate research in some cohorts while limiting the study of relatively benign conditions and the accrual of unaffected and unbiased control samples. BioVU represents a feasible model for pediatric DNA biobanking but involves both ethical and practical considerations specific to the pediatric population.

背景与目标： : BioVU Vanderbilt DNA存储库将剩余临床血液样本中的DNA链接到已识别的电子病历 (EMRs)。在开始收集成人样本后，儿科扩展需要考虑儿科特有的伦理问题，并实施专门的DNA提取方法。在儿科样本收集的第一年，包括来自18岁以下个体的11,000多个样本。我们将来自儿科BioVU队列的数据与来自范德比尔特大学医学中心总体儿科人群的数据进行了比较，发现了相似的人口统计学特征; 然而，BioVU队列的选择疾病，药物暴露和实验室测试的发生率更高，表明严重或慢性疾病的代表丰富。样本积累不平衡的事实可能会加速某些队列的研究，同时限制对相对良性条件的研究以及未受影响和无偏见的对照样本的积累。BioVU代表了儿科DNA生物库的可行模型，但涉及针对儿科人群的伦理和实践考虑。

BACKGROUND & AIMS: BACKGROUND:Kidney cancer accounts for over 4000 UK deaths annually, and is one of the cancer sites with a poor mortality record compared with Europe. AIM:To identify and quantify all clinical features of kidney cancer in primary care. DESIGN:Case-control study, using General Practice Research Database records. METHOD:A total of 3149 patients aged ≥40 years, diagnosed with kidney cancer between 2000 and 2009, and 14 091 age, sex and practice-matched controls, were selected. Clinical features associated with kidney cancer were identified, and analysed using conditional logistic regression. Positive predictive values for features of kidney cancer were estimated. RESULTS:Cases consulted more frequently than controls in the year before diagnosis: median 16 consultations (interquartile range 10-25) versus 8 (4-15): P<0.001. Fifteen features were independently associated with kidney cancer: visible haematuria, odds ratio 37 (95% confidence interval [CI] = 28 to 49), abdominal pain 2.8 (95% CI = 2.4 to 3.4), microcytosis 2.6 (95% CI = 1.9 to 3.4), raised inflammatory markers 2.4 (95% CI = 2.1 to 2.8), thrombocytosis 2.2 (95% CI = 1.7 to 2.7), low haemoglobin 1.9 (95% CI = 1.6 to 2.2), urinary tract infection 1.8 (95% CI = 1.5 to 2.1), nausea 1.8 (95% CI = 1.4 to 2.3), raised creatinine 1.7 (95% CI = 1.5 to 2.0), leukocytosis 1.5 (95% CI = 1.2 to 1.9), fatigue 1.5 (95% CI = 1.2 to 1.9), constipation 1.4 (95% CI = 1.1 to 1.7), back pain 1.4 (95% CI = 1.2 to 1.7), abnormal liver function 1.3 (95% CI = 1.2 to 1.5), and raised blood sugar 1.2 (95% CI = 1.1 to 1.4). The positive predictive value for visible haematuria in patients aged ≥60 years was 1.0% (95% CI = 0.8 to 1.3). CONCLUSION:Visible haematuria is the commonest and most powerful single predictor of kidney cancer, and the risk rises when additional symptoms are present. When considered alongside the risk of bladder cancer, the overall risk of urinary tract cancer from haematuria warrants referral.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Long-term, low-level exposure to toxic elements in soil may be harmful to human health but large longitudinal cohort studies with sufficient follow-up time to study these effects are cost-prohibitive and impractical. Linkage of routinely collected medical outcome data to systematic surveys of soil quality may offer a viable alternative. METHODS:We used the Geochemical Baseline Survey of the Environment (G-BASE), a systematic X-ray fluorescence survey of soil inorganic chemistry throughout England and Wales to obtain estimates of the concentrations of 15 elements in the soil contained within each English and Welsh postcode area. We linked these data to the residential postcodes of individuals enrolled in The Health Improvement Network (THIN), a large database of UK primary care medical records, to provide estimates of exposure. Observed exposure levels among the THIN population were compared with expectations based on UK population estimates to assess representativeness. RESULTS:Three hundred seventy-seven of three hundred ninety-five English and Welsh THIN practices agreed to participate in the linkage, providing complete residential soil metal estimates for 6,243,363 individuals (92% of all current and former patients) with a mean period of prospective computerised medical data collection (follow-up) of 6.75 years. Overall agreement between the THIN population and expectations was excellent; however, the number of participating practices in the Yorkshire & Humber strategic health authority was low, leading to restricted ranges of measurements for some elements relative to the known variations in geochemical concentrations in this area. CONCLUSIONS:The linked database provides unprecedented population size and statistical power to study the effects of elements in soil on human health. With appropriate adjustment, results should be generalizable to and representative of the wider English and Welsh population.

背景与目标：

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: OBJECTIVE:This study evaluated whether serious bacterial infections are more frequent at family practices with lower antibiotic prescribing rates. DESIGN:Cohort study. SETTING:706 UK family practices in the Clinical Practice Research Datalink from 2002 to 2017. PARTICIPANTS:10.1 million registered patients with 69.3 million patient-years' follow-up. EXPOSURES:All antibiotic prescriptions, subgroups of acute and repeat antibiotic prescriptions, and proportion of antibiotic prescriptions associated with specific-coded indications. MAIN OUTCOME MEASURES:First episodes of serious bacterial infections. Poisson models were fitted adjusting for age group, gender, comorbidity, deprivation, region and calendar year, with random intercepts representing family practice-specific estimates. RESULTS:The age-standardised antibiotic prescribing rate per 1000 patient-years increased from 2002 (male 423; female 621) to 2012 (male 530; female 842) before declining to 2017 (male 449; female 753). The median family practice had an antibiotic prescribing rate of 648 per 1000 patient-years with 95% range for different practices of 430-1038 antibiotic prescriptions per 1000 patient-years. Specific coded indications were recorded for 58% of antibiotic prescriptions at the median family practice, the 95% range at different family practices was from 10% to 75%. There were 139 759 first episodes of serious bacterial infection. After adjusting for covariates and the proportion of coded consultations, there was no evidence that serious bacterial infections were lower at family practices with higher total antibiotic prescribing. The adjusted rate ratio for 20% higher total antibiotic prescribing was 1.03, (95% CI 1.00 to 1.06, p=0.074). CONCLUSIONS:We did not find population-level evidence that family practices with lower total antibiotic prescribing might have more frequent occurrence of serious bacterial infections overall. Improving the recording of infection episodes has potential to inform better antimicrobial stewardship in primary care.

背景与目标：

BACKGROUND & AIMS: :The main goal of this study was to reconstruct the Late Pleistocene-Holocene floristic composition in an area of the northern Brazilian Amazonia, comparing the results with other Amazonian localities in order to discuss the factors that have influenced phytophysiognomic changes over this time period. The work in eastern Marajó Island at the mouth of the Amazonas River was approached based on analysis of 98 pollen and diatom samples from core data distributed along a proximal to distal transect of a paleoestuarine system. The results indicated high concentration of Rhizophora, associated with arboreal pollen grains typical of the modern Amazonian rainforest during the last 40,000 cal yrs BP. Pollen composition also included wetland herbs. Diatoms were dominated by marine and fresh water taxa. Wetland forest, mangrove and, subordinately herbs remained constant during most of the latest Pleistocene-early/middle Holocene. At 5,000 cal yrs BP, there was a distinguished change from forest and mangrove to wet grassland savanna due to sea level fluctuation. As marine influence decreased, the estuary gave rise to fresh water lacustrine and swamp environments, with establishment of herbaceous campos. A main conclusion from this study is that solely the occurrence of herbaceous savanna can not be used as a definitive indicator of past dry climates in Amazonian areas.

背景与目标： : 这项研究的主要目的是重建巴西北部亚马逊地区的晚更新世-全新世植物区系，并将结果与其他亚马逊地区进行比较，以讨论在此期间影响植物生理学变化的因素。根据沿古河口系统的近端到远端横断面分布的核心数据对98个花粉和硅藻样本进行的分析，对亚马逊河河口的东部maraj ó 岛的工作进行了研究。结果表明，在过去的40,000年BP中，根瘤菌的浓度很高，与现代亚马逊雨林中典型的树栖花粉粒有关。花粉成分还包括湿地草药。硅藻以海洋和淡水分类群为主。在最新的更新世-早/中全新世的大部分时间里，湿地森林，红树林和次生草药保持不变。在BP 5,000年，由于海平面波动，从森林和红树林到湿草原稀树草原发生了显着变化。随着海洋影响的减少，河口形成了淡水湖相和沼泽环境，并建立了草本campos。这项研究的主要结论是，仅草本稀树草原的发生不能用作亚马逊地区过去干旱气候的确切指标。

BACKGROUND & AIMS: :The 2009 American Recovery and Reinvestment Act spurred adoption of electronic health records (EHRs) in the United States, through such measures as financial incentives to providers through Medicare and Medicaid and regional extension centers, which provide ongoing technical assistance to practices. Yet the relationship between EHR adoption and quality of care remains poorly understood. We evaluated the early effects on quality of the Primary Care Information Project, which provides subsidized EHRs and technical assistance to primary care practices in underserved neighborhoods in New York City, using the regional extension center model. We found that just general participation in, or exposure to, the project was not enough to improve quality of care. It took sustained exposure on the part of these practices and technical assistance to them before they demonstrated improvement on measures of care most likely to be affected by the use of electronic health records, such as cancer screenings and care for patients with diabetes. Participating in the Primary Care Information Project for nine or more months was associated with significantly improved quality, but only for this limited group of quality measures and only for physicians receiving extensive technical assistance.

背景与目标： : 2009的《美国复苏和再投资法案》 (American Recovery and Reinvestment Act) 通过诸如通过Medicare和Medicaid以及区域扩展中心向提供者提供财务激励等措施，刺激了电子健康记录 (ehr) 在美国的采用，这些措施为实践提供持续的技术援助。然而，EHR采用与护理质量之间的关系仍然知之甚少。我们评估了初级保健信息项目对质量的早期影响，该项目使用区域扩展中心模型为纽约市服务不足的社区的初级保健实践提供补贴的ehr和技术援助。我们发现，仅仅参与或接触该项目不足以提高护理质量。这些做法和技术援助需要持续暴露，然后才证明最有可能受到电子健康记录使用影响的护理措施有所改善，例如癌症筛查和糖尿病患者护理。参与初级保健信息项目9个月或更长时间与质量显着提高有关，但仅适用于这一有限的质量措施组，并且仅适用于接受广泛技术援助的医生。

BACKGROUND & AIMS: OBJECTIVE:Clinician narrative style in electronic health records (EHR) has rarely been investigated. Clinicians sometimes record brief quotations from patients, possibly more frequently when higher risk is perceived. We investigated whether the frequency of quoted phrases in an EHR was higher in time periods closer to a suicide attempt. DESIGN:A case-crossover study was conducted in a large mental health records database. A natural language processing tool was developed using regular expression matching to identify text occurring within quotation marks in the EHR. SETTING:Electronic records from a large mental healthcare provider serving a geographic catchment of 1.3 million residents in South London were linked with hospitalisation data. PARTICIPANTS:1503 individuals were identified as having a hospitalised suicide attempt from 1 April 2006 to 31 March 2017 with at least one document in both the case period (1-30 days prior to admission) and the control period (61-90 days prior to admission). OUTCOME MEASURES:The number of quoted phrases in the control as compared with the case period. RESULTS:Both attended (OR 1.05, 95% CI 1.02 to 1.08) and non-attended (OR 1.15, 95% CI 1.04 to 1.26) clinical appointments were independently higher in the case compared with control period, while there was no difference in mental healthcare hospitalisation (OR 0.99, 95% CI 0.98 to 1.01). In addition, there was no difference in the levels of quoted text between the comparison time periods (OR 1.09, 95% CI 0.91 to 1.30). CONCLUSIONS:This study successfully developed an algorithm to identify quoted speech in text fields from routine mental healthcare records. Contrary to the hypothesis, no association between this exposure and proximity to a suicide attempt was found; however, further evaluation is warranted on the way in which clinician-perceived risk might be feasibly characterised from clinical text.

背景与目标：

BACKGROUND & AIMS: :The Electronic Medical Records and Genomics Network is a National Human Genome Research Institute-funded consortium engaged in the development of methods and best practices for using the electronic medical record as a tool for genomic research. Now in its sixth year and second funding cycle, and comprising nine research groups and a coordinating center, the network has played a major role in validating the concept that clinical data derived from electronic medical records can be used successfully for genomic research. Current work is advancing knowledge in multiple disciplines at the intersection of genomics and health-care informatics, particularly for electronic phenotyping, genome-wide association studies, genomic medicine implementation, and the ethical and regulatory issues associated with genomics research and returning results to study participants. Here, we describe the evolution, accomplishments, opportunities, and challenges of the network from its inception as a five-group consortium focused on genotype-phenotype associations for genomic discovery to its current form as a nine-group consortium pivoting toward the implementation of genomic medicine.

背景与目标： : 电子病历和基因组学网络是由国家人类基因组研究所资助的财团，致力于开发使用电子病历作为基因组研究工具的方法和最佳实践。现在已经进入第六年和第二个资助周期，由九个研究小组和一个协调中心组成，该网络在验证从电子病历中得出的临床数据可以成功用于基因组研究的概念方面发挥了重要作用。当前的工作是在基因组学和医疗保健信息学的交叉点上提高多个学科的知识，尤其是电子表型，全基因组关联研究，基因组医学实施以及与基因组学研究相关的伦理和监管问题，并将结果返回给研究参与者。在这里，我们描述了网络的发展，成就，机遇和挑战，从其成立为五组联盟，专注于基因组发现的基因型-表型关联，到目前的形式为九组联盟，转向实施基因组医学。

BACKGROUND & AIMS: BACKGROUND:Routine weight recording in electronic health records (EHRs) could assist general practitioners (GPs) in the identification, prevention, and management of overweight patients. However, the extent to which weight management is embedded in general practice in the Netherlands has not been investigated. The purpose of this study was to evaluate the frequency of weight recording in general practice in the Netherlands for patients who self-reported as being overweight. The specific objectives of this study were to assess whether weight recording varied according to patient characteristics, and to determine the frequency of weight recording over time for patients with and without a chronic condition related to being overweight. METHODS:Baseline data from the Occupational and Environmental Health Cohort Study (2012) were combined with data from EHRs of general practices (2012-2015). Data concerned 3446 self-reported overweight patients who visited their GP in 2012, and 1516 patients who visited their GP every year between 2012 and 2015. Logistic multilevel regression analyses were performed to identify associations between patient characteristics and weight recording. RESULTS:In 2012, weight was recorded in the EHRs of a quarter of patients who self-reported as being overweight. Greater age, lower education level, higher self-reported body mass index, and the presence of diabetes mellitus, chronic obstructive pulmonary disease, and/or cardiovascular disorders were associated with higher rates of weight recording. The strongest association was found for diabetes mellitus (adjusted OR = 10.3; 95% CI [7.3, 14.5]). Between 2012 and 2015, 90% of patients with diabetes mellitus had at least one weight measurement recorded in their EHR. In the group of patients without a chronic condition related to being overweight, this percentage was 33%. CONCLUSIONS:Weight was frequently recorded for overweight patients with a chronic condition, for whom regular weight measurement is recommended in clinical guidelines, and for which weight recording is a performance indicator as part of the payment system. For younger patients and those without a chronic condition related to being overweight, weight was less frequently recorded. For these patients, routine recording of weight in EHRs deserves more attention, with the aim to support early recognition and treatment of overweight.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Hypersensitivity reactions (HSRs) are immunologic responses to drugs. Identification of HSRs documented in the electronic health record (EHR) is important for patient safety. OBJECTIVE:To examine HSR epidemiology using longitudinal EHR data from a large United States health care system. METHODS:Patient demographic information and drug allergy data were obtained from the Partners Enterprise-wide Allergy Repository for 2 large tertiary care hospitals from 2000 to 2013. Drug-induced HSRs were categorized into immediate and delayed HSRs based on typical phenotypes. Causative drugs and drug groups were assessed. The prevalence of HSRs was determined, and sex and racial differences were analyzed. RESULTS:Among 2.7 million patients, 377,474 (13.8%) reported drug-induced HSRs, of whom 70.3% were female and 77.5% were white. A total of 580,456 HSRs were reported, of which 53.1% were immediate reaction phenotypes. Common immediate HSRs included hives (48.8%), itching (15.0%), and angioedema (14.1%). Delayed HSR phenotypes (46.9%) were largely rash (99.0%). Penicillins were associated with the most immediate (33.0%) and delayed (39.0%) HSRs. Although most HSRs were more prevalent in females and white patients, notable differences were identified for certain rare HSRs including acute interstitial nephritis, which appeared more commonly in males (0.02% vs 0.01%, P < .001). Asian patients had more fixed drug eruptions (0.007% vs 0.002%, P = .021) and severe cutaneous adverse reactions (0.05% vs 0.04%, P < .001). CONCLUSIONS:Drug HSRs were reported in 13.8% of patients. Almost one-half of reported immediate HSR phenotypes were hives, and almost all reported delayed HSR phenotypes were rash. HSRs largely affected female and white patients, but differences were identified for specific rare HSRs.

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