Limits...
Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice.

Russell WS, Farrar JR, Nowak R, Hays DP, Schmitz N, Wood J, Miller J - World J Emerg Med (2013)

Bottom Line: Data analysis included 207 EM providers.Most provided some written materials, and follow-up with a primary care clinician was recommended.Prospective research is recommended.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Emergency Department, Medical University of South Carolina, Charleston, SC 29425, USA.

ABSTRACT

Background: Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting. Current guidelines recommend: 1) quick diagnosis using standard criteria; 2) first-line treatment with epinephrine; and 3) discharge with a prescription for an epinephrine auto-injector, written instructions regarding long-term management, and a referral (preferably, allergy) for follow-up. However, studies suggest low concordance with guideline recommendations by emergency medicine (EM) providers. The study aimed to evaluate how emergency departments (EDs) in the United States (US) manage anaphylaxis in relation to guideline recommendations.

Methods: This was an online anonymous survey of a random sample of EM health providers in US EDs.

Results: Data analysis included 207 EM providers. For respondent EDs, approximately 9% reported using agreed-upon clinical criteria to diagnose anaphylaxis; 42% reported administering epinephrine in the ED for most anaphylaxis episodes; and <50% provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge. Most provided some written materials, and follow-up with a primary care clinician was recommended.

Conclusions: This is the first cross-sectional survey to provide "real-world" data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis, treatment, and follow-up of patients with anaphylaxis. The primary gaps are low (or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine. Prospective research is recommended.

No MeSH data available.


Related in: MedlinePlus

Use of a written definition of anaphylaxis in US EDs. Respondents answered the question: Does your department have a written definition of anaphylaxis? (n=204).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4129832&req=5

Figure 1: Use of a written definition of anaphylaxis in US EDs. Respondents answered the question: Does your department have a written definition of anaphylaxis? (n=204).

Mentions: Almost 90% of respondents reported that their EDs did not use a written definition of anaphylaxis (Figure 1). Thirty-two of 196 (16.3%) respondents stated that their EDs used a definition based on an established set of criteria (question 2): 17 of these respondents (8.9% of the total) reported using definitions based on consensus criteria recommended by the NIAID/FAAN 2nd Symposium[5] (1.6%), the 2010 US Practice Parameters[4] (4.2%), or the WAO guidelines[3,6] (3.1%) as the source of their definition.


Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice.

Russell WS, Farrar JR, Nowak R, Hays DP, Schmitz N, Wood J, Miller J - World J Emerg Med (2013)

Use of a written definition of anaphylaxis in US EDs. Respondents answered the question: Does your department have a written definition of anaphylaxis? (n=204).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129832&req=5

Figure 1: Use of a written definition of anaphylaxis in US EDs. Respondents answered the question: Does your department have a written definition of anaphylaxis? (n=204).
Mentions: Almost 90% of respondents reported that their EDs did not use a written definition of anaphylaxis (Figure 1). Thirty-two of 196 (16.3%) respondents stated that their EDs used a definition based on an established set of criteria (question 2): 17 of these respondents (8.9% of the total) reported using definitions based on consensus criteria recommended by the NIAID/FAAN 2nd Symposium[5] (1.6%), the 2010 US Practice Parameters[4] (4.2%), or the WAO guidelines[3,6] (3.1%) as the source of their definition.

Bottom Line: Data analysis included 207 EM providers.Most provided some written materials, and follow-up with a primary care clinician was recommended.Prospective research is recommended.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Emergency Department, Medical University of South Carolina, Charleston, SC 29425, USA.

ABSTRACT

Background: Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting. Current guidelines recommend: 1) quick diagnosis using standard criteria; 2) first-line treatment with epinephrine; and 3) discharge with a prescription for an epinephrine auto-injector, written instructions regarding long-term management, and a referral (preferably, allergy) for follow-up. However, studies suggest low concordance with guideline recommendations by emergency medicine (EM) providers. The study aimed to evaluate how emergency departments (EDs) in the United States (US) manage anaphylaxis in relation to guideline recommendations.

Methods: This was an online anonymous survey of a random sample of EM health providers in US EDs.

Results: Data analysis included 207 EM providers. For respondent EDs, approximately 9% reported using agreed-upon clinical criteria to diagnose anaphylaxis; 42% reported administering epinephrine in the ED for most anaphylaxis episodes; and <50% provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge. Most provided some written materials, and follow-up with a primary care clinician was recommended.

Conclusions: This is the first cross-sectional survey to provide "real-world" data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis, treatment, and follow-up of patients with anaphylaxis. The primary gaps are low (or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine. Prospective research is recommended.

No MeSH data available.


Related in: MedlinePlus