Department of Emergency Medicine, Mayo Clinic Health System, Austin and Albert Lea, Minnesota.
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
Ann Allergy Asthma Immunol. 2024 Nov;133(5):592-599.e8. doi: 10.1016/j.anai.2024.08.006. Epub 2024 Aug 17.
Prompt epinephrine administration is important to improve outcomes in anaphylaxis.
To assess the impact of prehospital epinephrine on clinical outcomes of hospital admission, biphasic reactions, and emergency department (ED) length of stay (LOS) in a cohort of ED patients who had anaphylaxis including both children and adults.
We conducted a single-center prospective and retrospective cohort study of patients who had anaphylaxis from April 2008 to December 2022. Associations between prehospital epinephrine administration with biphasic reactions and ED LOS were assessed with univariable models and the association with ED disposition was assessed with both univariable and multivariable logistic regression.
A total of 1107 patient visits were included for analysis. The median patient age was 29 (IQR: 14-50), 593 (53.6%) patients were of female sex, and 366 (33.1%) were younger than 18 years of age. Patients in the prehospital epinephrine group were also less likely to experience a biphasic reaction (5.4% vs 9.3%; odds ratio [OR] 0.56, 95% CI: 0.34-0.92) and had a decreased ED LOS (median 4.0 hours vs 4.7 hours). There was no difference in hospital admission between patients with and without prehospital epinephrine in both the univariable (19.5% vs 15.7%; OR 1.30, 95% CI: 0.94-1.79) and multivariable (adjusted OR 1.08, 95% CI: 0.71-1.64) models.
Prehospital epinephrine administration reduced the odds of a biphasic reaction and decreased ED LOS but did not reduce hospitalization in this cohort of ED patients who had anaphylaxis. Our findings suggest that timely administration of prehospital epinephrine is associated with improved patient outcomes.
及时给予肾上腺素对改善过敏反应的结局很重要。
评估在包括儿童和成人在内的过敏反应急诊科患者队列中，院前给予肾上腺素对住院、双相反应和急诊科（ED）住院时间（LOS）的影响。
我们对 2008 年 4 月至 2022 年 12 月期间发生过敏反应的患者进行了一项单中心前瞻性和回顾性队列研究。使用单变量模型评估院前给予肾上腺素与双相反应和 ED LOS 的关系，使用单变量和多变量逻辑回归评估与 ED 处置的关系。
共纳入 1107 次就诊进行分析。患者的中位年龄为 29（IQR：14-50）岁，593 名（53.6%）患者为女性，366 名（33.1%）患者年龄小于 18 岁。院前给予肾上腺素的患者发生双相反应的可能性也较小（5.4% vs 9.3%；比值比 [OR] 0.56，95%CI：0.34-0.92），ED LOS 也较短（中位数 4.0 小时 vs 4.7 小时）。单变量（19.5% vs 15.7%；OR 1.30，95%CI：0.94-1.79）和多变量（调整后 OR 1.08，95%CI：0.71-1.64）模型中，院前给予肾上腺素与住院之间均无差异。
在该急诊科过敏反应患者队列中，院前给予肾上腺素可降低双相反应的几率和 ED LOS，但不能降低住院率。我们的研究结果表明，及时给予院前肾上腺素与改善患者结局相关。
