Outcomes Associated with Prehospital Epinephrine in Adult and Pediatric Anaphylaxis Patients.

Autor:	Hlady AL; Department of Emergency Medicine, Mayo Clinic Health System, Austin and Albert Lea, MN, USA., Weinman AF; Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA., Zhang Y; Department of Emergency, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, China., Mullan AF; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA., Campbell RL; Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA. Electronic address: Campbell.ronna@mayo.edu.
Jazyk:	angličtina
Zdroj:	Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology [Ann Allergy Asthma Immunol] 2024 Aug 16. Date of Electronic Publication: 2024 Aug 16.
DOI:	10.1016/j.anai.2024.08.006
Abstrakt:	Background: Prompt epinephrine administration is important to improve outcomes in anaphylaxis. Objective: The objective of our study was to assess the impact of prehospital epinephrine on clinical outcomes of hospital admission, biphasic reactions, and ED length of stay (LOS) in a cohort of ED anaphylaxis patients including both children and adults. Methods: We conducted a single-center prospective and retrospective cohort study of anaphylaxis patients 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 female, 366 (33.1%) were under 18 years of age. Patients in the prehospital epinephrine group were also less likely to experience a biphasic reaction (5.4% vs 9.3%; 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 (aOR 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 anaphylaxis patients. Our findings suggest that timely administration of prehospital epinephrine is associated with improved patient outcomes. Competing Interests: Declaration of competing interest Andrea L. Hlady has no disclosures. Aliza F. Weinman has no disclosures. Yuedan Zhang has no disclosures. Aidan F. Mullan has no disclosures. Ronna L. Campbell has received royalties from UpToDate and was a consultant for Bryn Pharma. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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