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Pediatricians manage anaphylaxis poorly regardless of episode severity
Oksan Derinoz1, Arzu Bakirtas, Mustafa Arga
1Department of Pediatric Emergency, Gazi University Faculty of Medicine, Ankara, Turkey.
Insights
Pediatricians struggle with managing both mild and severe anaphylaxis, showing significant knowledge gaps in observation and discharge criteria. These deficiencies may lead to increased mortality from severe cases and recurrent mild episodes.
Area of Science:
- Pediatric Allergy and Immunology
- Emergency Medicine
- Clinical Practice Guidelines
Background:
- Limited data exists on pediatrician knowledge regarding anaphylaxis management based on episode severity.
- Understanding these variations is crucial for improving patient outcomes.
Purpose of the Study:
- To assess and compare pediatrician knowledge on managing mild versus severe anaphylaxis.
- To identify factors influencing their clinical decisions in anaphylaxis cases.
Main Methods:
- A questionnaire with eight questions on anaphylaxis diagnosis and management was administered to pediatricians at national congresses.
- Two clinical scenarios (mild and severe anaphylaxis) were used to evaluate initial treatment, monitoring, and discharge recommendations.
Main Results:
- Only 11.3% and 3.2% of pediatricians correctly answered all questions for mild and severe anaphylaxis, respectively.
- Pediatricians demonstrated better initial treatment knowledge but were less informed on observation and discharge criteria for mild cases compared to severe ones.
- Working in emergency or intensive care units was the only factor predicting correct anaphylaxis diagnosis, not management knowledge.
Conclusions:
- Pediatricians exhibit knowledge deficits in managing both mild and severe anaphylaxis.
- These management deficiencies pose risks, potentially increasing mild anaphylaxis recurrence and severe anaphylaxis mortality.
Background:
No information exists on how the knowledge or the practice of pediatricians regarding anaphylaxis episodes vary with episode severity. The aim of this study was to assess and compare pediatrician knowledge on the management of mild and severe anaphylaxis using clinical scenarios and to determine factors that affect their decisions.
Methods:
A questionnaire consisting of eight questions on the diagnosis and management of anaphylaxis was distributed at two national congresses. A uniform answer box including possible response choices was given below each question, and respondents were asked to check the answers that they thought appropriate. The management of mild and severe anaphylaxis was examined using two clinical case scenarios involving initial treatment, monitoring, and discharge recommendations.
Results:
Four hundred and ten questionnaires were analyzed. The percentage of pediatricians who correctly answered all questions on the management of mild and severe anaphylaxis scenarios was 11.3% and 3.2%, respectively. Pediatricians did significantly better with initial treatment, but they were less knowledgeable with respect to observation time and discharge criteria in the mild anaphylaxis case scenario compared with the severe one (both P < 0.001). Multiple logistic regression analysis identified only working in an emergency department or intensive care unit as significantly predicting correct diagnosis of anaphylaxis among pediatricians (P = 0.01, 95% confidence interval: 0.11-0.57). No pediatrician-related factors predicted physician knowledge on the management of anaphylaxis.
Conclusions:
Pediatricians have difficulty with different steps in managing mild and severe anaphylaxis. Their deficiencies in management may result in failure to prevent recurrences of mild anaphylaxis and may increase mortality in severe anaphylaxis.
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