Researchers identify predictors of anaphylaxis undertreatment
Anaphylaxis is often underdiagnosed and undertreated in children, but researchers at a busy tertiary care pediatric ED in Canada said they identified factors that predicted whether patients received epinephrine.
“Predictors for epinephrine undertreatment have been poorly studied,” Neta Cohen, MD, of the division of pediatric emergency medicine at the University of Toronto, and colleagues wrote.
To address the research gap, the researchers reviewed charts of 368 children (median age, 5.4 years) who presented with anaphylaxis-like symptoms to a Toronto ED.
They reported that 90.8% of the children were diagnosed correctly with anaphylaxis. Despite the high percentage of children who received a correct diagnosis, nearly a quarter (23.7%) were not treated with epinephrine. Of these, 13 had full resolution of signs and symptoms during the ED presentation.
According to the researchers, anaphylaxis first occurring at home, the first-ever occurrence of anaphylaxis and mild reaction were all predictors of patients not receiving epinephrine (P < .01). These three predictors remained significant in a multiple regression analysis (adjusted OR = 0.49; 95% CI, 0.2–0.8, aOR = 0.46; 95% CI, 0.2-0.8 and aOR = 0.54; 95% CI, 0.2-0.9, respectively).
“This is the first North American study to explore the rates of correct diagnosis in patients presenting to the pediatric ED with anaphylaxis by using retrospective chart revalidation,” Cohen and colleagues wrote. “Ongoing efforts should be made to promote epinephrine treatment and patient education.”