Abstract:
:Despite multiple recommendations, intramuscular epinephrine is poorly prescribed in emergency department receiving pediatric anaphylaxis. To evaluate the role of severity symptoms on this use, we included all admissions for a diagnosis linked to possible allergy in the two pediatric emergency departments of our institution between January 2010 and December 2015. Selection and analysis were restricted to children under 18 years fulfilling Sampson's criteria for anaphylaxis. We retrospectively ranked these admissions with the Ring and Messmer anaphylaxis severity score and compared the use of epinephrine according to this classification. Among 422,483 admissions, 204 (0.05%) fulfilled the anaphylaxis criteria (170 (83.3%) grade II anaphylaxis, and 34 (16.7%) grade III; mean age 7.9 years). Previous allergy, anaphylaxis, and asthma were found in respectively 60.8%, 36.8%, and 35.1%. Food allergy was the main suspected causal trigger. Epinephrine was used in 32.7% (n = 65/199), before admission (11.4% (n = 23/201)) or in the emergency department (22.2% (n = 45/202)). Epinephrine was more frequently prescribed in grade III than in grade II anaphylaxis (84.8% vs 22.3%, p < 0.001; OR = 19.05 [7.05-54.10]). Upon discharge, epinephrine auto-injectors prescription and allergy referral were rare (31.7% and 44.2%).Conclusion: Pediatricians intuitively adapt their epinephrine use to the severity of the anaphylaxis and contribute to epinephrine underuse in pediatric anaphylaxis. What is known: • Intramuscular epinephrine is the recommended treatment for pediatric anaphylaxis. However, most of the European and North-American studies show a low prescription rate of epinephrine in both prehospital and pediatric emergency department management. • Reasons for such a low prescription rate are unknown. What is new: • This study confirms that intramuscular epinephrine is poorly prescribed in pediatric anaphylaxis (about one case among 10 before admission and one among 5 in pediatric emergency departments). • Despite recommendations, pediatricians intuitively adapt their prescription to the clinical severity of anaphylaxis, with a fourfold increase prescription in grade III compared to grade II anaphylaxis. This medical behavior ascertainment may be in part explained by the delay between the ED admission/management and the anaphylactic episode onset.
journal_name
Eur J Pediatrjournal_title
European journal of pediatricsauthors
Dubus JC,Lê MS,Vitte J,Minodier P,Boutin A,Carsin A,Viudes G,Noel Gdoi
10.1007/s00431-018-3246-3subject
Has Abstractpub_date
2019-01-01 00:00:00pages
69-75issue
1eissn
0340-6199issn
1432-1076pii
10.1007/s00431-018-3246-3journal_volume
178pub_type
杂志文章abstract::We report here our experience in the long-term management of 28 patients with citrullinaemia, 13 patients with carbamoyl phosphate synthase deficiency and 15 patients with argininosuccinic aciduria. In addition, we report a national French survey of 119 patients with ornithine transcarbamylase (OTC) deficiency enzymat...
journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/pl00014323
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abstract:UNLABELLED:A prospective study was conducted to determine the serotypes and antibiotic resistance patterns of pneumococcal isolates from children with invasive pneumococcal disease (IPD) and acute otitis media (AOM). From October 2001 to May 2002, 65 children with IPD (28 bacteraemic pneumonia, 24 bacteraemia without f...
journal_title:European journal of pediatrics
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doi:10.1007/s00431-004-1447-4
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abstract::By November 1994, 39 pregnancies had been completed in phenylketonuric mothers. Dietary control was post-conception in 6 and 2 of these offspring died of congenital heart disease and 1 other needed surgery for coarctation. There were no heart defects in the 34 offspring of the 33 pregnancies following preconception di...
journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/pl00014242
更新日期:1996-07-01 00:00:00
abstract::In recent years, a more stable AVP surrogate, called copeptin, has been used as an adjuvant diagnostic tool for dysnatremia in adults and appears to be promising even in the pediatric age. The aim of this study is to present the distribution of plasma copeptin in a large pediatric cohort and to observe the influence o...
journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/s00431-020-03777-3
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journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/BF00595915
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journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/BF00451907
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abstract::Early diagnosis and treatment of phenylketonuria (PKU) in Poland was started in 1965, initially on a voluntary and then on a obligatory basis. Guthrie tests have been used for newborn screening. For confirmation of diagnosis changing with time methods of blood phenylalanine (Phe) and tyrosine estimation were used. In ...
journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/pl00014250
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abstract:UNLABELLED:Fifty-two cases of childhood brucellosis which occurred in north-western Greece during the 15-year period 1979-1993, are reviewed. It is believed that they represent very closely the total incidence of the disease in the region which has a population of 100,000 children aged 0-14 years old. Brucellosis-affec...
journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/BF02115616
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abstract::The total height gain was studied in 19 adult male subjects with non-tumorous hypopituitarism after they had been treated with human growth hormone (hGH) for more than 3 years and achieved final adult height. In patients with a history of breech delivery or severe perinatal asphyxia, a high multiple correlation was fo...
journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/BF00442688
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journal_title:European journal of pediatrics
pub_type: 杂志文章,多中心研究
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更新日期:1999-12-01 00:00:00
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journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/s00431-021-03955-x
更新日期:2021-01-20 00:00:00
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journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/s00431-018-3215-x
更新日期:2018-10-01 00:00:00
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journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/s00431-006-0132-1
更新日期:2006-08-01 00:00:00
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journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/s00431-018-3225-8
更新日期:2018-11-01 00:00:00
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journal_title:European journal of pediatrics
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1996-08-01 00:00:00
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journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/s00431-009-1047-4
更新日期:2010-04-01 00:00:00
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journal_title:European journal of pediatrics
pub_type: 杂志文章,评审
doi:10.1007/s00431-007-0600-2
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journal_title:European journal of pediatrics
pub_type: 杂志文章,评审
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journal_title:European journal of pediatrics
pub_type: 临床试验,杂志文章
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journal_title:European journal of pediatrics
pub_type: 杂志文章
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pub_type: 杂志文章
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journal_title:European journal of pediatrics
pub_type: 杂志文章
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journal_title:European journal of pediatrics
pub_type: 杂志文章
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pub_type: 评论,社论
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journal_title:European journal of pediatrics
pub_type: 杂志文章
doi:10.1007/BF01959224
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pub_type: 撤回出版物
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journal_title:European journal of pediatrics
pub_type: 杂志文章
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pub_type: 杂志文章,评审
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