Usability and preference of epinephrine auto-injectors

Abstract

Background: Despite the importance of prompt epinephrine auto-injector (EAI) treatment during anaphylaxis, proper administration technique is often lacking among patients and caregivers. Objective: To compare usability and participant preference of Auvi-Q and EpiPen Jr EAIs in a simulated lifethreatening allergic emergency-use scenario. Methods: In this randomized, crossover, human-factors usability study, untrained adults (18-65 years) were tasked with using 0.15 mg Auvi-Q and EpiPen Jr trainers to simulate epinephrine administration to a childsized manikin. Only written instructions on the device label and/or device voice instructions were available to participants. Endpoints included completing injection tasks per device instructions (primary endpoint), completing key injection tasks, and participant preference/ratings of devices. Completion of injection tasks were evaluated using a McNemar test for paired dichotomous data. Results: Ninety-six adults were included in study analyses. Significantly more participants completed all injection tasks per device instructions with Auvi-Q (85.4%) vs EpiPen Jr (19.8%; P < .001). Significant differences were also observed for completion of key injection tasks (Auvi -Q, 94.8%; EpiPen Jr, 72.9%; P < .001). No digital/hand injection errors were seen with Auvi-Q, whereas 14 participants (14.6%) would have accidentally received a digital/hand injection with EpiPen Jr (P < .001). Overall, significantly more participants preferred Auvi-Q over EpiPen Jr (91.7% vs 6.3%; P < .001 [2.1% no preference]). Median scores for 8 EAI characteristics were also higher for Auvi-Q vs EpiPen Jr. Conclusion: In this study, untrained adults preferred and were more likely to use Auvi-Q correctly vs EpiPen Jr, highlighting the importance of device design for successful epinephrine administration during a lifethreatening allergic emergency.

Patient Ability to Use Old versus New/Modified Model Adrenaline Autoinjection Emergency Medical Devices for Anaphylaxis in Prehospital Setting: A Systematic Review and Meta-Analysis

“…Participants in the trials were randomly placed into intervention and control groups. For three trials, the participants involved were crossovers [19,20,22]. For Six of the seven trials were conducted in high-income countries [18][19][20][21][22][23] and one trial in a middle-income country [17].…”

“…For three trials, the participants involved were crossovers [19,20,22]. For Six of the seven trials were conducted in high-income countries [18][19][20][21][22][23] and one trial in a middle-income country [17]. Three of the seven trials recruited participants from healthcare settings [18,21,23], two trials recruited participants from university settings [17,22], and two trials recruited participants from research/laboratory facilities [19,20].…”

“…Publication bias: None Large effect: Large tervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio GRADE Working Group grades of evidence nty: We are very confident that the true effect lies close to that of the estimate of the effect : We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect y: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect Seven trials documented the number of individuals who completed all steps [17][18][19][20][21][22][23]. The number of individuals who completed all steps was lower in the old model AAI group compared to the group using the new/modified model AAI device (RR 0.57, 95% CI 0.33 to 0.97; I2 statistic = 95%; p = 0.04; seven trials, 2196 participants; low quality evidence) (Figure 5, Table 2).…”

“…We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect Seven trials reported data regarding whether the device was held in place for adequate time after administration [17][18][19][20][21][22][23]. There was no significant difference between the old model AAI and control groups (RR 0.77, 95% CI 0.59 to 1.01; I2 statistic = 94%; p = 0.06; seven trials, 2196 participants; moderate quality evidence) (Figure 8, Table 2).…”

“…There was no significant difference between the old model AAI and control groups (RR 0.77, 95% CI 0.59 to 1.01; I2 statistic = 94%; p = 0.06; seven trials, 2196 participants; moderate quality evidence) (Figure 8, Table 2). Four trials reported a significant increase in the frequency of the adverse event (digital injection) in the old model AAI group [17,20,22,23] (RR 6.90, 95% CI 3.27 to 14.57; I2 statistic = 0%; p < 0.001; four trials, 610 participants; high quality evidence) (Figure 9, Table 2). Two trials reported significant reduction in patient overall preference of old model AAI compared to other AAI devices with substantial heterogeneity [19,20] (RR 0.12, 95% CI 0.05 to 0.29; I2 statistic = 82%; p < 0.001; two trials, 1578 participants; high quality evidence) (Figure 10, Table 2).…”