American College of Allergy, Asthma and Immunology Annual Meeting
American College of Allergy, Asthma and Immunology Annual Meeting
Perspective from Margaret Redmond, MD
November 30, 2018
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Emphasizing, reassessing epinephrine use improves outcomes

Perspective from Margaret Redmond, MD
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A clinical pathway that emphasized early epinephrine use and reassessed its use before IV placement improved outcomes in pediatric patients with allergy, according to findings presented at the American College of Allergy, Asthma and Immunology Annual Scientific Meeting.

“Emergency department management of anaphylaxis has not kept pace with advances in knowledge. Epinephrine use and utilization of guideline-based practice recommendations remains suboptimal, particularly in children,” researchers wrote.

They utilized a pathway that highlighted early epinephrine use and re-evaluated its use prior to IV placement on 936 patients in a pediatric ED.

Researchers found that when comparing patient outcomes 3 years before and 10 months after first using the pathway, the mean time to epinephrine for Emergency Severity Index 1 patients dropped from 11.3 minutes to 4.3 minutes. The proportion of patients with anaphylaxis receiving ED IV placement dropped from 40.7% to 19.9%. In addition, the incidence of using a less-sedating H1 blocker in combination with an H2 blocker escalated from 15.8% to 52.8% when an H1 antihistamine was used. However, the proportion of patients admitted to the hospital and mean length of ED stay for discharged patients with anaphylaxis did not change.

Researchers wrote a future analysis will seek shortening ED observation periods to lessen the time low-risk patients spend in the hospital. – by Janel Miller

Reference: Brown J, et al. Improving emergency care for anaphylaxis: Impact of a clinical pathway in a pediatric emergency department. Presented at: American College of Allergy, Asthma and Immunology Annual Scientific Meeting; Nov. 15-19, 2018; Seattle.

Disclosures: Please see the meeting’s abstract book for the authors’ relevant financial disclosures.