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Variation and Trends in Anaphylaxis Care in United States Children's Hospitals

Kenneth A Michelson1, Michael C Monuteaux1, Mark I Neuman1

  • 1Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|February 3, 2016
PubMed

Insights

Treatment for pediatric anaphylaxis varies significantly across U.S. children's hospitals, with increasing emergency department visits. This highlights a need for standardized anaphylaxis care guidelines.

Area of Science:

  • Pediatric Emergency Medicine
  • Allergy and Immunology
  • Health Services Research

Background:

  • Anaphylaxis is a severe allergic reaction requiring prompt management.
  • Current treatment protocols for pediatric anaphylaxis exhibit considerable variation in clinical practice.
  • Rising incidence of anaphylaxis necessitates an evaluation of care standards.

Purpose of the Study:

  • To quantify the variation in the utilization of common anaphylaxis treatments among children.
  • To assess disparities in hospitalization and emergency department (ED) revisit rates for pediatric anaphylaxis.
  • To identify temporal trends in ED visits for anaphylaxis in pediatric hospitals.

Main Methods:

  • Retrospective analysis of 10,351 pediatric patients diagnosed with anaphylaxis.
  • Inclusion of data from 35 U.S. children's hospitals between 2009 and 2013.
  • Evaluation of variations in medications (e.g., beta-agonists, glucocorticoids) and interventions (e.g., IV fluids, oxygen).

Main Results:

  • Significant hospital-level variation observed in the use of beta-agonists (median 22%), glucocorticoids (median 71%), H1 antagonists (median 60%), H2 antagonists (median 53%), inhaled epinephrine (median 2.2%), IV fluids (median 26%), and oxygen (median 2.6%).
  • Hospitalization rates varied widely from 12% to 95% (median 41%).
  • Anaphylaxis diagnoses increased from 5.7 to 11.7 per 10,000 ED visits between 2009 and 2013.

Conclusions:

  • Substantial variability exists in the management of pediatric anaphylaxis and hospitalization rates across U.S. children's hospitals.
  • Emergency department visits for anaphylaxis are on the rise in pediatric facilities.
  • Further research is crucial to establish evidence-based guidelines for optimal pediatric anaphylaxis care.
Abstract

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