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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

Percentage of patients seen in the ED for anaphylaxis who were discharged with a prescription for self-injectable epinephrine. Respondents answered the question: What percentage of patients treated for anaphylaxis in your ED is discharged with a prescription for self-injectable epinephrine? (n=197).
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Figure 3: Percentage of patients seen in the ED for anaphylaxis who were discharged with a prescription for self-injectable epinephrine. Respondents answered the question: What percentage of patients treated for anaphylaxis in your ED is discharged with a prescription for self-injectable epinephrine? (n=197).

Mentions: Ninety-five (48.2%) of the 196 respondents reported that >75% of patients seen for anaphylaxis were discharged with a prescription for an epinephrine auto-injector (Figure 3). However, 61 respondents (31%) reported that in their ED ≤50% of patients received such a prescription.


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)

Percentage of patients seen in the ED for anaphylaxis who were discharged with a prescription for self-injectable epinephrine. Respondents answered the question: What percentage of patients treated for anaphylaxis in your ED is discharged with a prescription for self-injectable epinephrine? (n=197).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Percentage of patients seen in the ED for anaphylaxis who were discharged with a prescription for self-injectable epinephrine. Respondents answered the question: What percentage of patients treated for anaphylaxis in your ED is discharged with a prescription for self-injectable epinephrine? (n=197).
Mentions: Ninety-five (48.2%) of the 196 respondents reported that >75% of patients seen for anaphylaxis were discharged with a prescription for an epinephrine auto-injector (Figure 3). However, 61 respondents (31%) reported that in their ED ≤50% of patients received such a prescription.

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