Outcomes associated with prehospital epinephrine in adult and pediatric patients with anaphylaxis

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology Pub Date : 2024-11-01 DOI:10.1016/j.anai.2024.08.006

Andrea L. Hlady MD, PhD , Aliza F. Weinman MD, MPH , Yuedan Zhang MD , Aidan F. Mullan MA , Ronna L. Campbell MD, PhD

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引用次数: 0

Abstract

Background

Prompt epinephrine administration is important to improve outcomes in anaphylaxis.

Objective

To assess the impact of prehospital epinephrine on clinical outcomes of hospital admission, biphasic reactions, and emergency department (ED) length of stay (LOS) in a cohort of ED patients who had anaphylaxis including both children and adults.

Methods

We conducted a single-center prospective and retrospective cohort study of patients who had anaphylaxis from April 2008 to December 2022. Associations between prehospital epinephrine administration with biphasic reactions and ED LOS were assessed with univariable models and the association with ED disposition was assessed with both univariable and multivariable logistic regression.

Results

A total of 1107 patient visits were included for analysis. The median patient age was 29 (IQR: 14-50), 593 (53.6%) patients were of female sex, and 366 (33.1%) were younger than 18 years of age. Patients in the prehospital epinephrine group were also less likely to experience a biphasic reaction (5.4% vs 9.3%; odds ratio [OR] 0.56, 95% CI: 0.34-0.92) and had a decreased ED LOS (median 4.0 hours vs 4.7 hours). There was no difference in hospital admission between patients with and without prehospital epinephrine in both the univariable (19.5% vs 15.7%; OR 1.30, 95% CI: 0.94-1.79) and multivariable (adjusted OR 1.08, 95% CI: 0.71-1.64) models.

Conclusion

Prehospital epinephrine administration reduced the odds of a biphasic reaction and decreased ED LOS but did not reduce hospitalization in this cohort of ED patients who had anaphylaxis. Our findings suggest that timely administration of prehospital epinephrine is associated with improved patient outcomes.

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成人和儿童过敏性休克患者院前注射肾上腺素的相关结果。

背景：及时注射肾上腺素对改善过敏性休克的预后非常重要：及时注射肾上腺素对改善过敏性休克的预后非常重要：我们的研究旨在评估院前肾上腺素对包括儿童和成人在内的一组急诊室过敏性休克患者入院、双相反应和急诊室住院时间（LOS）等临床结果的影响：我们对 2008 年 4 月至 2022 年 12 月期间的过敏性休克患者进行了一项单中心前瞻性和回顾性队列研究。通过单变量模型评估了院前肾上腺素给药与双相反应和急诊室住院时间之间的关系，并通过单变量和多变量逻辑回归评估了与急诊室处置之间的关系：共纳入 1107 次患者就诊进行分析。患者年龄中位数为 29 岁（IQR 14-50），593 名（53.6%）患者为女性，366 名（33.1%）患者未满 18 岁。院前肾上腺素组患者发生双相反应的几率也较低（5.4% 对 9.3%；OR 0.56，95% CI 0.34-0.92），急诊室等待时间也较短（中位数 4.0 小时对 4.7 小时）。在单变量模型（19.5% vs 15.7%；OR 1.30，95% CI：0.94-1.79）和多变量模型（aOR 1.08，95% CI：0.71-1.64）中，使用和未使用院前肾上腺素的患者入院率没有差异：院前注射肾上腺素降低了双相反应的发生几率，缩短了急诊室的住院时间，但并未减少急诊室过敏性休克患者的住院率。我们的研究结果表明，及时给予院前肾上腺素可改善患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Allergy Asthma & Immunology 医学-过敏

CiteScore

6.50

自引率

6.80%

发文量

437

审稿时长

33 days

期刊介绍： Annals of Allergy, Asthma & Immunology is a scholarly medical journal published monthly by the American College of Allergy, Asthma & Immunology. The purpose of Annals is to serve as an objective evidence-based forum for the allergy/immunology specialist to keep up to date on current clinical science (both research and practice-based) in the fields of allergy, asthma, and immunology. The emphasis of the journal will be to provide clinical and research information that is readily applicable to both the clinician and the researcher. Each issue of the Annals shall also provide opportunities to participate in accredited continuing medical education activities to enhance overall clinical proficiency.