Background:To date, few studies have evaluated the degree of compliance with recommendations of anaphylaxis guidelines in emergency departments (EDs). Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines recommendations in an ED of a tertiary hospital. Methods: Medical records of patients that were assisted in the ED of the University Hospital of Salamanca (Spain) were reviewed. Those patients fulfilling anaphylaxis criteria proposed by the NIAID/FAAN were selected. Results: During one year period, we identified 89 patients, 74 adults and 15 children. In the 65% of adults the anaphylactic reaction was moderate, in 34% severe and in 1% very severe. In children, all reactions were moderate. Less than half (42%) of patients received adrenaline at ED, which was administered intramuscularly only in 19% of the cases. Regarding the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were no treated with adrenaline. At discharge from ED, an adrenaline auto-injector was recommended only to 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs. 27% children, p=0.047), 29% instructions about avoidance of triggers (31% adults vs. 20% children, n.s.), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs. 100% children, p<0.001). Conclusion: The results of the study show a large discrepancy between guidelines recommendations and anaphylaxis management in ED. Additional efforts in education to improve the treatment of patients with anaphylactic reactions are needed.
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