Emergency Management of Anaphylaxis in Chinese Primary Care Units: Systematic Analysis of 77 Cases

Abstract

Background Anaphylaxis is a potentially fatal medical emergency and prompt, appropriate administration of epinephrine is critical. However, the actual clinical practices of emergency management of anaphylaxis in Chinese primary care remain unclear.Objective To evaluate the actual emergency management of anaphylaxis in Chinese primary care units compared to current guidelines.Methods Systematic analysis of published case reports of anaphylaxis initially treated in Chinese primary care units from January 2014 through December 2018.Results A total of 77 cases were included in this analysis. The patients came from 22 provinces of China. Mean age was 42 years, and 49 (64.5%) were male. All the patients developed severe anaphylactic reactions, with mortality rate of 5.2%. Only 21 (27.3%) patients received epinephrine as first-line intervention. The first dose of epinephrine ranged from 0.0625 mg to 0.5 mg in children and 0.1 mg to1.0 mg in adults. The percentage of adult patients who received initial epinephrine dose of 1.0 mg (73.7%) was significantly higher than that of 0.5 mg (19.3%; p < 0.001). The percentage of patients who received subcutaneous (SC), intramuscular (IM), or intravenous (IV) bolus injection was 44.3%, 36.1%, and 19.7%, respectively. Among patients who received epinephrine, 80.3% received an overdose. All the 5 patients who developed serious adverse effects associated with epinephrine had received an overdose, and 4 of these had received route of IV bolus injection.Conclusion and Clinical Relevance The actual emergency management of anaphylaxis in Chinese primary care is not consistent with current guidelines. Under-use, overdose and inappropriate route of epinephrine administration are the major problems. Targeted training is therefore strongly suggested for Chinese general practitioners.