Physician adherence to anaphylaxis guidelines among different age groups in emergency departments: 20-Year observational study

Chia Hua Ho, Hsin Ju Lee, Yu Hsin Yeh, Chun Chun Gau, Joo Wei Lim, Yu Tang Juan, Hsin Yi Huang, Hui Ju Tsai, Jing Long Huang*, Tsung Chieh Yao*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

Abstract

BACKGROUND: Anaphylaxis is an acute and serious allergic reaction. Little is known about physician adherence to anaphylaxis guidelines among patients across different age groups.

OBJECTIVE: To investigate real-world physician adherence to anaphylaxis guidelines among children, adults, and older adults in emergency departments.

METHODS: This study retrospectively analyzed all consecutive patients with anaphylaxis who presented to 2 emergency departments at 2 branches of the largest tertiary hospital in Taiwan, between 2001 and 2020. Patients who met the diagnostic criteria for anaphylaxis were enrolled and grouped by age: children (<18 years), adults (18-64 years), and older adults (≥65 years).

RESULTS: We enrolled 771 patients with anaphylaxis (159 children, 498 adults, and 114 older adults). Intramuscular epinephrine was administered in 294 cases (38.1%). There was a significant age-group difference in the rate of intramuscular epinephrine administration (46.5% in children, 37.3% in adults, and 29.8% in older adults; P trend = .004). When stratified by severity, 14.3% of older adults with moderate reactions received intramuscular epinephrine, whereas 35.2% of adults and 55.3% of children received intramuscular epinephrine (P trend < .001), whereas such difference was not found in patients with severe reactions. Upon discharge from emergency departments, 15.3% received allergist referral (52.2% in children, 6.6% in adults, and 1.8% in older adults; P trend < .001); 12.5% received education on avoidance of triggers (18.9%, 11.4%, and 7.9%; P trend = .01), and 16.1% received education on alarm symptoms (21.4%, 15.1%, and 13.2%; P trend = .05).

CONCLUSION: The real-world physician adherence to anaphylaxis guidelines remains suboptimal in emergency departments, particularly among older adults. Physician continuing education is needed to improve the gap between anaphylaxis guidelines and clinical practice.

Original languageEnglish
Pages (from-to)519-524.e2
JournalAnnals of Allergy, Asthma and Immunology
Volume132
Issue number4
DOIs
StatePublished - 04 2024

Bibliographical note

Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

Keywords

  • Adolescent
  • Aged
  • Child
  • Humans
  • Anaphylaxis/diagnosis
  • Emergency Service, Hospital
  • Epinephrine/therapeutic use
  • Injections, Intramuscular
  • Physicians
  • Retrospective Studies
  • Adult
  • Infant, Newborn
  • Child, Preschool
  • Young Adult
  • Middle Aged
  • Taiwan

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