477 - Factors associated with prehospital epinephrine use in pediatric anaphylaxis: a cross-sectional study

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 477
Publication Number: 477.31

Rachel E. Hatcliffe, Children's National Health System, Washington, DC, United States; Caleb E. Ward, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Madhuri Uppuluri, Children's National Health System, Reston, VA, United States; Gia M. Badolato, Children's National Health System, Washington, DC, United States; Kathleen M. Brown, George Washington University School of Medicine and Health Sciences, SILVER SPRING, MD, United States

Presenting Author(s)

Rachel E. Hatcliffe, MD (she/her/hers)

Pediatric Emergency Medicine Fellow
Children's National Health System
Washington, District of Columbia, United States

Background:

Anaphylaxis requires prompt recognition and treatment to reduce morbidity and mortality. The National Association of EMS Physicians recommends that all EMS clinicians should be able to administer epinephrine to patients with anaphylaxis. Previous studies show that EMS providers administered IM Epinephrine in 32-36% of children with anaphylaxis.

Objective:

Determine the patient demographic and encounter factors associated with treatment of pediatric anaphylaxis by EMS.

Design/Methods:

We conducted a single-center retrospective cross-sectional study using linked records from a large county EMS agency and a pediatric emergency department (ED). We screened all children < 18 years old transported by EMS to a tertiary care pediatric hospital from January 2016 to April 2021. Eligible patients were identified based on ICD-codes and/or documentation of receiving IM Epinephrine in the ED within 2 hours of arrival. Demographic and encounter data was extracted from the EMS and ED records. We calculated the proportion of children treated with IM epinephrine by EMS and conducted a multivariate logistic regression to determine factors associated with treatment after adjusting for age, gender and race/ethnicity.

Results:

We identified 117 children with anaphylaxis. Of these, only 29.9% (35) received prehospital IM epinephrine, while 70% (82) received their first dose in the ED. Factors associated with prehospital IM epinephrine administration included prehospital care by an Advanced Life Support (ALS) provider (adjusted Odds Ratio (aOR) 5.6; 95% CI [1.8, 17.0]), prehospital respiratory symptoms (aOR 3.84; 95% CI [1.3, 11.2]) and public insurance (aOR 4.2; 95% CI [1.3-13.8]). Prehospital GI symptoms were associated with decreased prehospital IM epi use (aOR 0.15; 95% CI [0.05-0.41]. Median ED LOS of those patients treated with prehospital IM epi was 289.5 minutes (IQR+/- 128.0), compared to a median of 355.5 minutes (IQR +/-155.0) for those who did not receive treatment before arrival in the ED.

Conclusion(s):

Only 29.9% of children with anaphylaxis received appropriate prehospital treatment with IM epinephrine. Prehospital treatment was associated with care given by ALS providers, patient’s presenting with prehospital respiratory symptoms, and public insurance. Under treatment was associated with patients presenting with GI symptoms prior to arrival in the ED. Additionally, prehospital treatment was associated with a decreased ED LOS. Future research should include qualitative studies to explore reasons for under-treatment, and targeted educational and quality improvement efforts to improve prehospital performance.