Detection and management of Anaphylaxis in children

Rev Chil Pediatr. 2019;90(1):44-51. doi: 10.32641/rchped.v90i1.839. Epub 2019 Jan 2.
[Article in English, Spanish]

Abstract

Introduction: Anaphylaxis is an emergency condition. According to the latest international guide lines, early recognition and treatment with intramuscular epinephrine are associated with increased survival.

Objective: To determine the level of knowledge of pediatricians in a tertiary Pediatric Hos pital about the diagnostic criteria and treatment of anaphylaxis.

Material and method: A cross-sec tional descriptive study was conducted, designing, applying, and validating an anonymous survey to physicians with complete residency in pediatrics who are on call at a third level hospital. The statisti cal analysis was made using the SPSS v.21 software, presenting measures of central tendency (median, range, and frequency table) and Chi-square test for comparison. A value of p < 0.05 was considered significant.

Results: 71 physicians completed the survey with a median of three years after the end of residency.35% of them identified all clinical criteria, 99% (70) indicated epinephrine, 73% chose the intramuscular route, and 55% indicated the correct dose. Only 48% of responders chose the dose and administration route correctly. In general, 21% recognized anaphylaxis and used epinephrine correctly. Physicians with less than five years of experience performed better in the intramuscular administration of epinephrine (83% vs 52% p = 0.005) and in the detection of gastrointestinal symp toms (60% vs 35% p = 0.043).

Conclusions: There are difficulties in the identification and proper management of anaphylaxis by pediatricians of a tertiary Pediatric Hospital in a theoretical clinical setting. Although most of pediatricians chose epinephrine as a first-line drug, half of them did not indicate it correctly, and only one-third recognized anaphylaxis in all scenarios.

MeSH terms

  • Anaphylaxis / diagnosis*
  • Anaphylaxis / drug therapy*
  • Argentina
  • Child
  • Clinical Competence / statistics & numerical data*
  • Cross-Sectional Studies
  • Emergencies
  • Epinephrine / therapeutic use*
  • Guideline Adherence / statistics & numerical data*
  • Health Care Surveys
  • Hospitals, Pediatric
  • Humans
  • Injections, Intramuscular
  • Pediatricians / standards
  • Pediatricians / statistics & numerical data
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Sympathomimetics / therapeutic use*

Substances

  • Sympathomimetics
  • Epinephrine