Randomized comparison of caregivers' ability to use epinephrine autoinjectors and prefilled syringes for anaphylaxis

Caregivers often incorrectly use epinephrine autoinjectors. It is unclear whether this is due to insufficient training or a difficult-to-use tool. Furthermore, the high costs of epinephrine autoinjectors may limit their availability; so low-cost prefilled syringes may be the alternative.

We performed a prospective randomized trial to compare successful epinephrine administration at four stages: after reading written instructions, and immediately after, 6 weeks, and 3 months following video training. The time required for successful epinephrine administration and failed steps in the administration of epinephrine autoinjectors and prefilled syringe were also investigated.

Complete data analysis of 113 participants (prefilled syringe group, n=57; EpiPen, n=56) was performed. Significantly more participants correctly demonstrated the use of prefilled syringes compared to EpiPen after reading instructions, and immediately following 6 weeks, and 3 months after video training. ((adjusted OR 26.17 (95%CI 8.2583.04), adjusted OR 4.07 (95%CI 1.29-12.86), adjusted OR 14.01 (95%CI 3.62-54.22)) and adjusted OR 31.44 (95%CI 5.73172.39), respectively) Four key step errors would likely result in failure of administration and were more common with EpiPen (14.0% vs. 2.3%, p<0.001). There were no statistically significant differences in time of successful administration between the two groups (p>0.05).

Epinephrine prefilled syringe was significantly easier to use with a higher rate of correct use compared to EpiPen over time. All four key step errors in the administration were more likely with EpiPen. The time required for successful epinephrine administration was not significantly different.