New York State Cases Of Anaphylaxis In Elderly Patients From 2000 To 2010

Abstract

RATIONALE: Children with allergic reactions often present to the emergency department for treatment. We hypothesized that different types of medical providers, Allergy/Immunology (AI) and Emergency Medicine (EM), would vary in their approaches to management of allergic reactions. METHODS: This was a cross-sectional survey study of EM and AI providers in the University of Colorado hospitals and Colorado Asthma and Allergy Society. The survey consisted of 6 case scenarios of allergic reactions, with 4 representing anaphylaxis that resolved by the time of discharge. Following the scenarios, participants were asked questions about preferred initial therapy, adjunctive therapies, monitoring, outpatient prescription medications, and discharge instructions provided. Survey derivation and validation was accomplished by a multidisciplinary team of experts using a modified Delphi process. RESULTS: 194 of 413 (47%) clinicians responded, with 69 pediatric EM, 50 general EM, 49 AI providers; 26 did not complete demographics. For each clinical scenario there was a statistically significant difference in discharging patients with scheduled steroids: AI providers consistently reported fewer prescriptions than EM for scheduled steroids in all cases of resolved anaphylaxis (p values: 0.00000, 0.00018, 0.00012, 0.00274). In addition, AI providers were less likely to provide scheduled antihistamines than EM in half of the cases (p values: 0.00092 and 0.00010). CONCLUSIONS: Though current evidence does not support its use for all cases of anaphylaxis, most EM providers continued to prescribe scheduled steroids and antihistamines after resolution of anaphylaxis. These results support AI involvement in quality improvement practices within the emergency department.