國家衛生研究院 NHRI:Item 3990099045/15716
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    題名: Real-world adherence to anaphylaxis guidelines among different age groups in emergency departments: A Taiwan tertiary hospital experience from 2001 to 2020
    作者: Ho, CH;Lee, HJ;Yeh, YH;Yu, CY;Gau, CC;Lim, JW;Huang, HY;Tsai, HJ;Yao, TC
    貢獻者: Institute of Population Health Sciences
    摘要: Background: Anaphylaxis is a life-threatening clinical emergency. Anaphylaxis guidelines recommend prompt intramuscular injection of epinephrine, referral to an allergist, and patient education on avoidance of triggers and recognition of symptoms. Little is known about adherence to guidelines in the management of anaphylaxis among patients of different age groups in emergency departments (EDs). This study aimed to investigate real-world adherence to anaphylaxis guidelines among elders, adults, and children in EDs. Method: This study retrospectively reviewed electronic medical records of all consecutive patients with anaphylaxis presented to two EDs of Chang Gung Memorial Hospital, the largest tertiary hospital in Taiwan, from January 1, 2001, to December 31, 2020. Patients met the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria for anaphylaxis were enrolled and grouped by age: elders (≥65 years), adults (18–64 years), and children (<18 years). Results: A total of 766 patients (113 elders, 495 adults, and 158 children) were presented to our EDs with anaphylaxis over a 20-year period. Epinephrine (intramuscular, subcutaneous or intravenous) was administered in 391 (51.0%) of 766 anaphylaxis patients (45.1% elders, 51.5% adults, and 55.7% children; p = 0.320). Specifically, intramuscular epinephrine was administered in 30.1% of elders, 37.8% of adults, and 46.8% of children (p = 0.01). When stratified by severity, intramuscular epinephrine was more frequently administered in elders with severe anaphylaxis than moderate anaphylaxis (37.3% vs. 13.9%; p = 0.01), while such difference was not found in adults and children. Upon discharge from EDs, 15.3% of patients received documented allergist referral (2.6% elders, 6.7% adults, and 51.9% children; p < 0.001). Approximately 12.3% of patients received education on avoidance of triggers (8.0% elders, 11.1% adults, and 19.0% children; p = 0.01). Approximately 16.1% of patients received education on recognition of anaphylaxis symptoms (13.3% elders, 14.7% adults, and 22.2% children; p = 0.06). Conclusion: This real-world study demonstrates suboptimal adherence to anaphylaxis guidelines in EDs, particularly among elderly patients aged 65 years and above. Physician-targeted interventions are needed to close the gap between guidelines and clinical practice in the management of anaphylaxis.
    日期: 2023-12-28
    關聯: Allergy. 2023 Dec 28;78(Suppl. 112):309-310.
    Link to: http://dx.doi.org/10.1111/all.15925
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0105-4538&DestApp=IC2JCR
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