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Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency
Melissa Robinson1, Matthew Greenhawt2, David R Stukus3
1Section of Allergy and Immunology, National Jewish Hospital, Denver, Colorado.
Insights
Epinephrine, the primary treatment for anaphylaxis, is underused in prehospital settings. Factors like reaction location and severity influence its timely administration in children, necessitating increased awareness and education.
Area of Science:
- Pediatric Emergency Medicine
- Allergy and Immunology
- Public Health
Background:
- Epinephrine is the recommended first-line treatment for anaphylaxis.
- Underuse of epinephrine by patients and medical personnel is a concern.
Purpose of the Study:
- To identify factors influencing anaphylaxis management before emergency department (ED) or urgent care center (UCC) arrival.
- To evaluate the timeliness and patterns of prehospital epinephrine administration in pediatric patients.
Main Methods:
- Retrospective review of electronic medical records for patients aged 0-25 years presenting with anaphylaxis.
- Analysis of 408 patient records from 2009-2013 at a pediatric academic referral center.
Main Results:
- Only 36.3% of patients received epinephrine before ED/UCC arrival.
- Reactions at home were less likely to be treated with epinephrine compared to school reactions.
- Lower odds of prehospital epinephrine use were associated with multi-organ system involvement and home-based reactions.
Conclusions:
- Significant delays in epinephrine administration for pediatric anaphylaxis were observed.
- Increased awareness and education for caregivers, patients, and medical professionals are crucial for optimal anaphylaxis management.
- Factors such as reaction location and severity impact prehospital epinephrine use.
Background:
Epinephrine is the first-line treatment for anaphylaxis but may be underused by patients and medical personnel.
Objective:
To evaluate factors associated with anaphylaxis management before arrival at the emergency department (ED) or urgent care center (UCC).
Methods:
We performed a retrospective review of electronic medical records for all patients aged 0 to 25 years presenting with anaphylaxis to the ED or UCC at a pediatric academic referral center during 2009 to 2013.
Results:
A total of 408 patients (mean age, 7.25 years; 62% male) were included for analysis. Only 148 patients (36.3%) received epinephrine before arrival at the ED or UCC. Reactions occurring at home (n = 36/114) were less likely to be treated with epinephrine compared with reactions occurring at school (n = 30/49) (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.15-0.59). The odds of receiving epinephrine before arrival at the ED or UCC were significantly lower with a 2-organ system (OR, 0.50; 95% CI, 0.30-0.85) or 3-organ system (OR, 0.41; 95% CI, 0.21-0.81) presentation compared with 1-organ system involvement. Foods (342 [83.8%]) were the most commonly reported provoking trigger. Patients who did not receive epinephrine before arrival at the ED or UCC were significantly less likely to be discharged to home (OR, 0.56; 95% CI, 0.37-0.86; P = .01).
Conclusion:
This study identifies factors associated with prehospital management of anaphylaxis for children, which highlight that epinephrine administration may be occurring with considerable delay. Increased awareness and education of caregivers, patients, and medical professionals are necessary to provide optimal management.
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