Murad Ari, Katelaris Constance Helen
Campbelltown Hospital, Sydney, NSW 2560, Australia.
Campbelltown Hospital, Sydney, NSW 2560, Australia.; Western Sydney University, Sydney, NSW 2150, Australia.
Asia Pac Allergy. 2016 Jan;6(1):29-34. doi: 10.5415/apallergy.2016.6.1.29. Epub 2016 Jan 27.
Deficiencies in anaphylaxis management in Emergency Departments is well recognised despite established guidelines for its treatment.
To identify deficiencies in the management of anaphylaxis in a busy metropolitan Emergency Department and determine if an education intervention could correct these.
Paediatric and adult admissions to the Emergency Department of a busy hospital were tracked over a 10-month period with a targeted educational program being instituted at 5 months. The electronic records were retrospectively reviewed looking for cases of anaphylaxis and milder forms of immediate type allergic reactions presenting with a combination of urticaria and nonairway threatening angioedema. Anaphylaxis presentation was graded using the Brown grading system. Use of all medication during resuscitation was documented. Observation period before discharge and referral to specialist unit for follow-up was noted.
In the first 5 months, 38 patients fulfilled our criteria. Three had severe anaphylaxis, 13 had moderately severe anaphylaxis and 12 had urticaria and angioedema without anaphylaxis. Anaphylaxis was not always recognised or graded leading to inappropriate management with adrenaline often being withheld. Promethazine, usually given in parenteral form, was frequently administered. Observation time was often inadequate. Referral to an immunologist was not universally followed through. Following the educational intervention 58 patients fulfilled our criteria over the next 5 months. The appropriate use of adrenaline increased by 21% and the use of sedating antihistamines decreased by 16%, while the number of referrals to an immunologist increased by 24%. There was an 11% reduction in the number of patients who were observed for at least 4 hours.
A number of deficiencies in the management of anaphylaxis presentations have been identified. Targeted educational activities aimed at the Emergency Department hospital staff may improve outcomes.
尽管有既定的过敏反应治疗指南，但急诊科在过敏反应管理方面的不足已得到广泛认可。
确定繁忙的大都市急诊科在过敏反应管理方面的不足，并确定教育干预措施是否能够纠正这些不足。
在10个月的时间里跟踪一家繁忙医院急诊科的儿科和成人入院患者，并在第5个月实施针对性的教育计划。回顾电子记录，寻找出现过敏反应以及表现为荨麻疹和无气道威胁性血管性水肿组合的较轻形式速发型过敏反应的病例。使用布朗分级系统对过敏反应表现进行分级。记录复苏期间所有药物的使用情况。记录出院前的观察期以及转介至专科单位进行随访的情况。
在最初的5个月里，38名患者符合我们的标准。3例为严重过敏反应，13例为中度严重过敏反应，12例为荨麻疹和血管性水肿但无过敏反应。过敏反应并不总是能被识别或分级，导致管理不当，肾上腺素常常未被使用。异丙嗪通常以注射形式给药，却经常被使用。观察时间往往不足。并非普遍落实转介至免疫科医生处就诊。在教育干预之后，在接下来的5个月里有58名患者符合我们的标准。肾上腺素的合理使用率提高了21%，镇静性抗组胺药的使用率下降了16%，而转介至免疫科医生处就诊的人数增加了24%。观察至少4小时的患者人数减少了11%。
已确定过敏反应处置管理方面存在一些不足。针对急诊科医院工作人员开展的针对性教育活动可能会改善治疗效果。
