加拿大两个儿科中心的过敏反应：评估管理差异。
Anaphylaxis across two Canadian pediatric centers: evaluating management disparities.
作者信息
Lee Alison Ym, Enarson Paul, Clarke Ann E, La Vieille Sébastien, Eisman Harley, Chan Edmond S, Mill Christopher, Joseph Lawrence, Ben-Shoshan Moshe
机构信息
Pediatric Residency Program, Department of Pediatrics, University of British Columbia, BC Children's Hospital.
Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC.
出版信息
J Asthma Allergy. 2016 Dec 30;10:1-7. doi: 10.2147/JAA.S123053. eCollection 2017.
BACKGROUND
There are no data on the percentage of visits due to anaphylaxis in the emergency department (ED), triggers, and management of anaphylaxis across different provinces in Canada.
OBJECTIVE
To compare the percentage of anaphylaxis cases among all ED visits, as well as the triggers and management of anaphylaxis between two Canadian pediatric EDs (PEDs).
METHODS
As part of the Cross-Canada Anaphylaxis Registry (C-CARE), children presenting to the British Columbia Children's Hospital (BCCH) and Montreal Children's Hospital (MCH) EDs with anaphylaxis were recruited. Characteristics, triggers, and management of anaphylaxis were documented using a standardized data entry form. Differences in demographics, triggers, and management were determined by comparing the difference of proportions and 95% confidence interval.
RESULTS
Between June 2014 and June 2016, there were 346 visits due to anaphylaxis among 93,730 PED visits at the BCCH ED and 631 anaphylaxis visits among 164,669 pediatric visits at the MCH ED. In both centers, the majority of cases were triggered by food (BCCH 91.3% [88.7, 94.0], MCH 82.4% [79.7, 85.3]), of which peanuts were the most common culprit (24.7% [20.9, 29.9] and 19.0% [15.8, 22.7], respectively). Pre-hospital administration of epinephrine (BCCH 27.7% [23.2, 32.8], MCH 33.1% [29.5, 37.0]) and antihistamines (BCCH 50.6% [45.2, 56.0], MCH 47.1% [43.1, 51.0]) was similar. In-hospital management differed in terms of increased epinephrine, antihistamine, and steroid use at the BCCH (59.2% [53.9, 64.4], 59.8% [54.4, 65.0], and 60.1% [54.7, 65.3], respectively) compared to the MCH (42.2% [38.3, 46.2], 36.2% [32.5, 40.1], and 11.9% [9.5, 14.8], respectively). Despite differences in management, percentage of cases admitted to the intensive care unit was similar between the two centers.
CONCLUSION
Compared to previous European and North American reports, there is a high percentage of anaphylaxis cases in two PEDs across Canada with substantial differences in hospital management practices. It is crucial to develop training programs that aim to increase epinephrine use in anaphylaxis.
背景
在加拿大，关于急诊科因过敏反应就诊的比例、诱因以及不同省份过敏反应的管理情况，尚无相关数据。
目的
比较加拿大两家儿科急诊科（PEDs）中，所有急诊科就诊病例中过敏反应病例的比例，以及过敏反应的诱因和管理情况。
方法
作为全加拿大过敏反应登记处（C-CARE）的一部分，招募了前往不列颠哥伦比亚儿童医院（BCCH）和蒙特利尔儿童医院（MCH）急诊科就诊且发生过敏反应的儿童。使用标准化数据录入表格记录过敏反应的特征、诱因和管理情况。通过比较比例差异和95%置信区间，确定人口统计学、诱因和管理方面的差异。
结果
在2014年6月至2016年6月期间，BCCH急诊科的93730次儿科就诊中有346次因过敏反应就诊，MCH急诊科的164669次儿科就诊中有631次过敏反应就诊。在两个中心，大多数病例由食物诱发（BCCH为91.3%[88.7,94.0]，MCH为82.4%[79.7,85.3]），其中花生是最常见的诱因（分别为24.7%[20.9,29.9]和19.0%[15.8,22.7]）。院前使用肾上腺素（BCCH为27.7%[23.2,32.8]，MCH为33.1%[29.5,37.0]）和抗组胺药（BCCH为50.6%[45.2,56.0]，MCH为47.1%[43.1,51.0]）情况相似。与MCH相比，BCCH在院内管理方面，肾上腺素、抗组胺药和类固醇的使用增加（分别为59.2%[53.9,64.4]、59.8%[54.4,65.0]和60.1%[54.7,65.3]），而MCH分别为42.2%[38.3,46.2]、36.2%[32.5,40.1]和11.9%[9.5,14.8]）。尽管管理存在差异，但两个中心进入重症监护病房的病例比例相似。
结论
与之前欧洲和北美的报告相比，加拿大两家儿科急诊科中过敏反应病例的比例较高，医院管理实践存在显著差异。制定旨在增加过敏反应中肾上腺素使用的培训项目至关重要。
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