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Management of anaphylaxis in Spain

pediatric emergency care providers’ knowledge

Olabarri, Mikela; Gonzalez-Peris, Sebastiác; Vázquez, Paulae; González-Posada, Aranzazuf; Sanz, Nuriad; Vinuesa, Anab; Diez, Nuriag; Benito, Javiera; Mintegi, Santiagoa

European Journal of Emergency Medicine: June 2019 - Volume 26 - Issue 3 - p 163–167
doi: 10.1097/MEJ.0000000000000515
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Background Acute care providers must diagnose and treat patients with anaphylaxis. The objective was to analyze Spanish pediatric emergency departments’ (ED) providers’ knowledge of the international recommendations for the management of anaphylaxis.

Methods A web-based survey including providers (both attending and residents) from seven Spanish pediatric EDs was conducted. To analyze the knowledge of the identification of anaphylaxis, we used the diagnostic criteria given by the National Institute of Allergy and Infectious Disease and Food Allergy and the Food Allergy and Anaphylaxis Network (2005). To analyze the management, we used the practical recommendations on the management of anaphylaxis published by the Joint Task Force on Practice Parameters (2014).

Results A total of 425 physicians received the link and 337 (79.2%) completed the survey (138 attending, 76.6%; 199 residents, 81.2%, P<0.05). More than 90% of the providers correctly identified the anaphylaxis, except for not diagnosing it when reduced blood pressure is detected after exposure to a known allergen (69.7%) and misdiagnosis of anaphylaxis in patients with progressive urticaria with significant angioedema (65.9%). Nearly 100% identified epinephrine as the first-line treatment. Main failures of treatment were related to the position of the patient, the effect of medications in preventing a biphasic reaction, the recommended time to observe patients, and those related to the follow-up. No significant differences were found between attendings and residents.

Conclusion Even though the Spanish pediatric ED providers’ knowledge of the management of anaphylaxis is good, certain improvement areas are identified in both the identification and the management of these patients.

aDepartment of Pediatric Emergency, Cruces University Hospital – Basque Country University

bDepartment of Pediatrics, Basurto University Hospital – Basque Country University, Bilbao

cDepartment of Pediatric Emergency, Vall d’Hebron University Hospital

dDepartment of Pediatric Emergency, Sant Joan de Déu Hospital, Barcelona

eDepartment of Pediatric Emergency, Gregorio Marañón University Hospital

fDepartment of Pediatric Emergency, 12 de Octubre Hospital, Madrid

gDepartment of Pediatrics, Río Hortega University Hospital, Valladolid, Spain

Received 7 June 2017 Accepted 3 October 2017

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.euro-emergencymed.com.

Correspondence to Santiago Mintegi, PhD, Department of Pediatric Emergency, Cruces University Hospital, Plaza de Cruces s/n. E-48903 Barakaldo, Bizkaia, Spain Tel: +34 94 6006463; fax: +34 94 6006076; e-mail: santiago.mintegi@osakidetza.eus

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