The diagnosis and management of children presenting with anaphylaxis to a metropolitan emergency department: A 2‐year retrospective case series

Nogic, Claire; Belousoff, Julie; Krieser, David

doi:10.1111/jpc.13173

Cited by 12 publications

(25 citation statements)

References 26 publications

(73 reference statements)

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“…In our cohort 58.3% of anaphylaxis patients received epinephrine during their care. This is consistent with previously reported rates of 19–94% [ 3 , 6 , 9 , 10 , 18 , 22 ]. In our cohort ED diagnosis had a significant impact on epinephrine administration.…”

Section: Discussionsupporting

confidence: 94%

“…In our cohort 51.7% of overall anaphylaxis presentations were prescribed an epinephrine autoinjector, while 7.1% already had one available. This is similar to the previous reported rates of 17.5–63.0% [ 3 , 4 , 6 , 10 , 13 , 19 , 22 , 31 ]. Correct anaphylaxis diagnosis had a profound impact on autoinjector prescription.…”

Section: Discussionsupporting

confidence: 93%

“…Overall 55.5% of patients received steroids and 81.5% of patients received an H1 antihistamine at some point in their care. These results are similar to those found in the Australian literature with steroid rates reported between 44-77% an antihistamine use reported as between 44-88% in pediatric anaphylaxis [ 9 – 11 , 22 ]. Australian guidelines acknowledge that while steroid use is common, their benefits in anaphylaxis is unproven and that antihistamines have no role in acute management of anaphylaxis [ 8 ].…”

Section: Discussionsupporting

confidence: 90%

“…The key to long-term care is referral to an allergist as they can verify triggers, provide education and offer immunotherapy [ 7 ]. Despite this, previous studies have reported referral rates between 24 and 71% [ 4 , 6 , 10 – 13 , 19 , 22 ]. In our cohort only 25.6% of overall anaphylaxis patients were referred to an allergist.…”

Section: Discussionmentioning

confidence: 93%

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Downstream consequences of diagnostic error in pediatric anaphylaxis

2018

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BackgroundPediatric anaphylaxis is commonly misdiagnosed in the Emergency Department (ED). We aimed to determine the impact of inaccurate diagnosis on the management and follow-up of pediatric anaphylaxis presenting to the ED.MethodsRetrospective chart review of ED management of children aged 0–18 years with allergic presentations to three EDs in Melbourne, Australia in 2014. Cases were included if an ED diagnosis of anaphylaxis was recorded, or the presentation met international consensus criteria for anaphylaxis.ResultsOf the 60,143 pediatric ED presentations during the study period, 1551 allergy-related presentations were identified and reviewed. 187 met consensus criteria for anaphylaxis, and another 24 were diagnosed with anaphylaxis without meeting criteria. Of the 211 presentations, 105 cases were given an ED diagnosis of anaphylaxis and 106 cases were given an alternative diagnosis in ED.Those diagnosed with anaphylaxis were more likely to receive epinephrine [85.7% vs 31.1% (OR = 13.27, 95% CI: 6.09–26.3)], to be observed for the recommended four hours [56.2% vs 29.2% (OR = 3.10, 95% CI 1.76–5.48, p < 0.001)], to have an epinephrine autoinjector available on discharge [81.9% vs 35.8% (OR = 4.12, 95% CI 2.07–8.22, p < 0.001)] and to be referred to an allergist [35.2% vs 16.0% (OR = 2.85, 95% CI 1.48–5.49, p < 0.01)]. Provision of anaphylaxis action plans and allergen avoidance advice was poorly documented for all patients.ConclusionAccurate diagnosis of anaphylaxis in ED has a significant impact on observation times, prescription of epinephrine autoinjectors and referral to an allergist. These factors are key to reducing mortality and the significant morbidity that results from childhood anaphylaxis.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1024-z) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 93%

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Downstream consequences of diagnostic error in pediatric anaphylaxis

2018

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“…This is in contrast to Nogic et al . who found that anaphylaxis was accurately diagnosed in 55 cases presenting to a Victorian ED . This difference in results is likely due to our inclusion of all children with the triage presenting complaint of ‘allergic reaction’ and the inclusion of additional diagnostic codes, such as allergy and angioedema.…”

Section: Discussionmentioning

confidence: 99%

Inaccurate diagnosis of paediatric anaphylaxis in three Australian Emergency Departments

Thomson

Seith

Craig

2017

J Paediatrics Child Health

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Anaphylaxis management in a French pediatric emergency department: Lessons from the ANA‐PED study

Clark,

Kase Tanno,

et al. 2023

Clinical & Translational All

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BackgroundAnaphylaxis is a serious systemic hypersensitivity reaction that requires immediate recognition and prompt administration of epinephrine/adrenaline. The present study aimed to assess the appropriateness of epinephrine/adrenaline use in children identified as allergic by physicians in the emergency department (ED) at the time of the reaction, and to identify factors that are possibly associated with epinephrine/adrenaline administration, auto‐injector prescription, and further referral to an allergist.MethodsWe performed a retrospective cross‐sectional study at the pediatric ED of the University Hospital of Montpellier, France. We included all consecutive children who attended the ED between 2016 and 2020 with an allergy‐related diagnosis at discharge.ResultsWe included 1056 allergy‐related visits, including 224 (21.2%) with a diagnosis of anaphylaxis at discharge; only 17.0% of them received an epinephrine/adrenaline injection, and 57.1% consulted an allergist after the acute episode. An auto‐injector was prescribed to 63 (28.1%) patients at discharge from the ED. Besides the severity of the clinical presentation, factors associated with a guidelines‐based management of the anaphylactic reaction and with an increased administration rate of epinephrine/adrenaline included presence of asthma symptoms and presence of extended skin reactions.ConclusionsOur study underlines persistent gaps in the management of pediatric anaphylaxis in ED, focusing on hereby identified levers. By disseminating current knowledge and guidelines on anaphylaxis and allergies, specialists could work together with emergency physicians to establish effective management algorithms and improve anaphylaxis management and care pathways for children experiencing allergic reactions, especially anaphylaxis.Trail RegistrationClinical Trials, number NCT05112367.

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The diagnosis and management of children presenting with anaphylaxis to a metropolitan emergency department: A 2‐year retrospective case series

Cited by 12 publications

References 26 publications

Downstream consequences of diagnostic error in pediatric anaphylaxis

Downstream consequences of diagnostic error in pediatric anaphylaxis

Inaccurate diagnosis of paediatric anaphylaxis in three Australian Emergency Departments

Anaphylaxis management in a French pediatric emergency department: Lessons from the ANA‐PED study

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