Department of Allergy, University Hospital of Salamanca, Spain.
Biosanitary Institute of Salamanca, IBSAL, Salamanca, Spain.
J Investig Allergol Clin Immunol. 2018;28(4):246-252. doi: 10.18176/jiaci.0243. Epub 2018 Feb 21.
Few studies have evaluated adherence to anaphylaxis guidelines in emergency departments (EDs). Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines in the ED of a tertiary hospital.
Medical records of patients attended in the ED of University Hospital of Salamanca, Spain were reviewed. Those patients fulfilling the anaphylaxis criteria proposed by the NIAID/FAAN were selected.
During a 1-year period, we identified 89 patients (74 adults and 15 children). The anaphylactic reaction was moderate in 65% of adults, severe in 34%, and very severe in 1%. In children, all reactions were moderate. Fewer than half of the patients (42%) received adrenaline in the ED; this was administered intramuscularly in only 19% of cases. As for the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were not treated with adrenaline. At discharge from the ED, an adrenaline auto-injector was recommended to only 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs 27% children, P=.047), 29% instructions about avoidance of triggers (31% adults vs 20% children, NS), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs 100% children, P<.001).
The results of the study show a large discrepancy between recommendations in guidelines and management of anaphylaxis in the ED. Additional training efforts are needed to improve the treatment of patients with anaphylactic reactions.
很少有研究评估过急诊部门（ED）中对过敏反应指南的遵循情况。目的：本研究旨在评估西班牙萨拉曼卡大学医院 ED 中对过敏反应指南的遵循情况。
回顾了在西班牙萨拉曼卡大学医院 ED 就诊的患者的病历。选择符合 NIAID/FAAN 提出的过敏反应标准的患者。
在 1 年期间，我们确定了 89 名患者（74 名成人和 15 名儿童）。成人中 65%的过敏反应为中度，34%为重度，1%为极重度。在儿童中，所有反应均为中度。不到一半的患者（42%）在 ED 中接受了肾上腺素；其中只有 19%的病例给予了肌肉内注射。至于反应的严重程度，65%的中度反应患者和 42%的重度反应患者未接受肾上腺素治疗。在 ED 出院时，仅向 5.6%的患者推荐了肾上腺素自动注射器。52%的患者接受了记录过敏转诊（57%的成人与 27%的儿童，P=.047），29%的患者接受了避免触发因素的指导（31%的成人与 20%的儿童，无统计学差异），51%的患者接受了过敏反应警告信号识别的书面说明（41%的成人与 100%的儿童，P<.001）。
研究结果表明，指南中的建议与 ED 中过敏反应的管理之间存在很大差异。需要进一步培训，以改善对过敏反应患者的治疗。
