From the Case Western Reserve University School of Medicine.
Pediatr Emerg Care. 2022 Aug 1;38(8):367-371. doi: 10.1097/PEC.0000000000002783. Epub 2022 Jun 13.
Anaphylaxis requires prompt assessment and management with epinephrine to reduce its morbidity and mortality. This study examined the prehospital management of pediatric anaphylactic reactions in Northeast Ohio.
This is a retrospective chart review using emergency medical service (EMS) run charts of patients 18 years and younger from February 2015 to April 2019. Patient charts with the diagnosis of "anaphylaxis" or "allergic reaction" were reviewed and confirmed that symptoms met anaphylaxis criteria. Information regarding epinephrine administration before EMS arrival and medications given by EMS providers was collected. Analysis was performed using descriptive statistics.
From 646 allergic/anaphylactic reaction EMS run charts, 150 (23%) met the guideline criteria for anaphylaxis. The median patient age was 12 years. Only 57% (86/150) of these patients received intramuscular epinephrine, and the majority received it before EMS arrival. Epinephrine was administered by EMS to 32% (30/94; 95% confidence interval [CI], 22.7% to 42.3%) of patients who had not already received epinephrine. The odds of receiving prehospital epinephrine were significantly lower for patients 5 years and younger (risk difference [RD], -0.23; 95% CI, -0.43 to -0.04), those with no history of allergic reaction (RD, -0.20; 95% CI, -0.38 to -0.03), those who presented with lethargy (RD, -0.43; 95% CI, -0.79 to -0.06), and those whose trigger was a medication or environmental allergen (RD, -0.47; 95% CI, -0.72 to -0.23 for each).
Emergency medical service providers in this region demonstrated similar use of epinephrine as reported elsewhere. However, 43% (64/150) of pediatric patients meeting anaphylaxis criteria did not receive prehospital epinephrine, and 10% (15/150) received no treatment whatsoever. Efforts to improve EMS provider recognition and prompt epinephrine administration in pediatric cases of anaphylaxis seem necessary.
过敏反应需要及时评估和管理，使用肾上腺素以降低发病率和死亡率。本研究检查了俄亥俄州东北部的儿科过敏反应的院前管理。
这是一项回顾性图表审查，使用了 2015 年 2 月至 2019 年 4 月期间年龄为 18 岁及以下的急诊医疗服务（EMS）运行图表。对诊断为“过敏反应”或“过敏反应”的患者图表进行了审查，并确认症状符合过敏反应标准。收集了 EMS 到达前肾上腺素给药和 EMS 提供者给予的药物的信息。使用描述性统计进行了分析。
在 646 份过敏/过敏反应的 EMS 运行图表中，有 150 份（23%）符合过敏反应的指南标准。中位患者年龄为 12 岁。只有 57%（86/150）的这些患者接受了肌肉内肾上腺素，而且大多数是在 EMS 到达前给予的。在未接受肾上腺素的 94 名患者中，有 32%（30/94；95%置信区间 [CI]，22.7%至 42.3%）的患者由 EMS 给予了肾上腺素。5 岁及以下的患者（差异风险 [RD]，-0.23；95%CI，-0.43 至 -0.04）、无过敏反应史的患者（RD，-0.20；95%CI，-0.38 至 -0.03）、表现为昏睡的患者（RD，-0.43；95%CI，-0.79 至 -0.06）和触发药物或环境过敏原的患者（RD，-0.47；95%CI，-0.72 至 -0.23）接受院前肾上腺素的可能性明显降低。
该地区的紧急医疗服务提供者使用肾上腺素的情况与其他地方报告的相似。然而，43%（64/150）符合过敏反应标准的儿科患者未接受院前肾上腺素治疗，10%（15/150）未接受任何治疗。似乎有必要努力提高 EMS 提供者对儿科过敏反应的认识，并促使其及时给予肾上腺素。
