Use of epinephrine in emergency department depends on anaphylaxis severity in children.

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 Pediatr

authors

Dubus JC,Lê MS,Vitte J,Minodier P,Boutin A,Carsin A,Viudes G,Noel G

doi

10.1007/s00431-018-3246-3

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

69-75

issue

1

eissn

0340-6199

issn

1432-1076

pii

10.1007/s00431-018-3246-3

journal_volume

178

pub_type

杂志文章
  • Complications of percutaneous liver biopsy in infants and children.

    abstract:UNLABELLED:In this study, 144 consecutive percutaneous liver biopsies performed with a 1.6 mm Menghini needle, during a 2-year period were reviewed. All the children were aged under 15 years, 57 patients less than 1 year and 87 more than 1 year. All biopsies were adequate and the mean number of portal tracts examined w...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/BF02079063

    authors: Lachaux A,Le Gall C,Chambon M,Regnier F,Loras-Duclaux I,Bouvier R,Pinzaru M,Stamm D,Hermier M

    更新日期:1995-08-01 00:00:00

  • Intracranial bleeding during therapy with L-asparaginase in childhood acute lymphocytic leukemia.

    abstract::Two patients developed clinical features of intracranial bleeding--which were confirmed by computerized axial tomograms--during their induction therapy for acute lymphocytic leukemia. Coagulation studies showed clotting abnormalities including severe hypofibrinogenemia. These findings most probably were related to the...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/BF00443266

    authors: Urban C,Sager WD

    更新日期:1981-11-01 00:00:00

  • Long-term outcomes in pediatric appendiceal carcinoids: Turkey experience.

    abstract::The tendency of non-operative management of appendicitis let us explore the natural history of appendiceal carcinoids, compare them with appendicitis patients, and determine the possibility of deciding the extent of the surgery and post-operative follow-up on behalf of the intraoperative findings. A retrospective revi...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s00431-018-3258-z

    authors: Akova F,Aydin E,Nur Eray Y,Toksoy N,Yalcin S,Altinay S,Tetikkurt US

    更新日期:2018-12-01 00:00:00

  • Nemaline myopathy in the neonate: two case reports.

    abstract:UNLABELLED:Nemaline myopathy, one of the most benign myopathies in older children and adults, may be rarely associated with early death in the neonate. The authors report two cases, describing the ante- and postnatal clinical courses. Family history may help in establishing the diagnosis, but this was not the case in t...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/BF01955190

    authors: Vendittelli F,Manciet-Labarchède C,Gilbert-Dussardier B

    更新日期:1996-06-01 00:00:00

  • Beyond pancreatic insufficiency and liver disease in cystic fibrosis.

    abstract:UNLABELLED:Cystic fibrosis is a life shortening hereditary disease, primarily leading to progressive pulmonary infection and exocrine pancreatic dysfunction. Several gastrointestinal complications other than malabsorption can arise during the disease course and with the progressively increasing life span of patients wi...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章,评审

    doi:10.1007/s00431-016-2719-5

    authors: Demeyer S,De Boeck K,Witters P,Cosaert K

    更新日期:2016-07-01 00:00:00

  • Improved neutrophil function in a glycogen storage disease type 1b patient after liver transplantation.

    abstract:UNLABELLED:Patients with glycogen storage disease type 1b (GSD1b) not only show hepatomegaly, hypoglycaemia and lactic acidosis, but also neutropenia and neutrophil dysfunction. Here, we report improvement of neutropenia and neutrophil function in a 22-year-old male GSD1b patient who had undergone living-related partia...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s00431-004-1405-1

    authors: Adachi M,Shinkai M,Ohhama Y,Tachibana K,Kuratsuji T,Saji H,Maruya E

    更新日期:2004-04-01 00:00:00

  • Primary ciliary dyskinesia, an orphan disease.

    abstract:UNLABELLED:Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disease, caused by specific primary structural and/or functional abnormalities of the motile cilia, in contrast with the transitory abnormalities seen in secondary ciliary dyskinesia. Disease-causing mutations in at least 16 genes have already be...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章,评审

    doi:10.1007/s00431-012-1785-6

    authors: Boon M,Jorissen M,Proesmans M,De Boeck K

    更新日期:2013-02-01 00:00:00

  • The Kabuki (Niikawa-Kuroki) syndrome: further delineation of the phenotype in 29 non-Japanese patients.

    abstract::The Kabuki (Niikawa-Kuroki) syndrome was reported in 1981 by Niikawa et al. and Kuroki et al. in a total of ten unrelated Japanese children with a characteristic array of multiple congenital anomalies and mental retardation. The syndrome is characterized by a distinct face, mild to moderate mental retardation, postnat...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/BF01983409

    authors: Schrander-Stumpel C,Meinecke P,Wilson G,Gillessen-Kaesbach G,Tinschert S,König R,Philip N,Rizzo R,Schrander J,Pfeiffer L

    更新日期:1994-06-01 00:00:00

  • The effect of L-asparaginase on lipid metabolism during induction chemotherapy of childhood lymphoblastic leukaemia.

    abstract::L-asparaginase is an effective antileukaemic drug and a potent inhibitor of hepatic protein synthesis. Its effect on lipid metabolism was studied in two cohorts of children with ALL, one of whom received L-asparaginase concomitantly with three other drugs (protocol BFM 79). In the second protocol (BFM 83) administrati...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/BF00442614

    authors: Cremer P,Lakomek M,Beck W,Prindull G

    更新日期:1988-01-01 00:00:00

  • Lymphocytic hypophysitis presenting with diabetes insipidus in a 14-year-old girl: case report and review of the literature.

    abstract:UNLABELLED:Lymphocytic hypophysitis is a rare disorder predominantly affecting females during the antepartum or postpartum period. It is characterized by destruction and lymphocytic infiltration of the pituitary gland, probably by an autoimmune process, leading to a pituitary mass lesion and/or various degrees of hypop...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章,评审

    doi:10.1007/s004310050690

    authors: Cemeroglu AP,Blaivas M,Muraszko KM,Robertson PL,Vázquez DM

    更新日期:1997-09-01 00:00:00

  • Neuroleptic malignant syndrome in a 4-year-old girl associated with alimemazine.

    abstract:UNLABELLED:Neuroleptic malignant syndrome (NMS) is a rare but serious disorder caused by antipsychotic medication including phenothiazines. For sedative purposes, increasing doses of alimemazine were administered to a 4-year-old multiple handicapped girl, with cerebral damage of the basal ganglia. She developed extra-p...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s00431-002-0956-2

    authors: van Maldegem BT,Smit LM,Touw DJ,Gemke RJ

    更新日期:2002-05-01 00:00:00

  • Plasma fibronectin levels in meningococcal disease.

    abstract:UNLABELLED:Fibronectin (a glycoprotein which modulates inflammation) may decrease mortality in systemic infection. Children with meningococcal disease (MCD) may have low fibronectin levels. We aimed to compare plasma fibronectin levels in children with MCD and controls, correlate fibronectin levels with interleukin-6 (...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s004310050636

    authors: Riordan FA,Bestwick K,Thomson AP,Sills JA,Hart CA

    更新日期:1997-06-01 00:00:00

  • Bone marrow hypoplasia in anorexia nervosa.

    abstract::Within a 2-year period, from March 1974 until May 1976 10 patients with anorexia nervosa were seen at the children's university hospitals of München (2 patients) and Giessen (8 patients). The patients were 10-16 years old, with one exception all girls, and had the typical cachexia, hypothermia, bradycardia, gray, hair...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/BF00452416

    authors: Lampert F,Lau B

    更新日期:1976-12-09 00:00:00

  • Demographic predictors of hospitalization and mortality in US children with COVID-19.

    abstract::Understanding which children are at increased risk for poor outcome with COVID-19 is critical. In this study, we link pediatric population-based data from the US Center for Disease Control and Prevention to COVID-19 hospitalization and in-hospital death. In 27,045 US children with confirmed COVID-19, we demonstrate th...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s00431-021-03955-x

    authors: Moreira A,Chorath K,Rajasekaran K,Burmeister F,Ahmed M,Moreira A

    更新日期:2021-01-20 00:00:00

  • Severe pulmonary arterial hypertension in type 1 glycogen storage disease.

    abstract::Pulmonary arterial hypertension is characterised by the presence of pulmonary hypertension (mean pulmonary artery pressure >25 mmHg at rest or >30 mmHg during exercise ) and normal pulmonary wedge pressure (<12 mmHg). Several risk factors for pulmonary arterial hypertension have been described. In the absence of any f...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s00431-002-1012-y

    authors: Humbert M,Labrune P,Simonneau G

    更新日期:2002-10-01 00:00:00

  • Surfactant therapy in neonates with respiratory failure due to haemorrhagic pulmonary oedema.

    abstract:UNLABELLED:We studied the clinical and biochemical factors associated with surfactant dysfunction and factors affecting the responsiveness to exogenous surfactant among 27 neonates with haemorrhagic pulmonary oedema (HPE). HPE was defined as the presence of a large amount of blood-stained lung effluent and respiratory ...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s00431-003-1276-x

    authors: Amizuka T,Shimizu H,Niida Y,Ogawa Y

    更新日期:2003-10-01 00:00:00

  • Growth of pulmonary artery after arterial switch operation for simple transposition of the great arteries.

    abstract:UNLABELLED:This retrospective study attempts to assess the size and growth pattern of the pulmonary artery about 1 year after neonatal arterial switch operation for simple transposition of the great arteries. Sixty-seven patients underwent cardiac catheterization, including catheterization of the right and left pulmona...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s004310050777

    authors: Massin MM,Nitsch GB,Däbritz S,Seghaye MC,Messmer BJ,von Bernuth G

    更新日期:1998-02-01 00:00:00

  • A national educational campaign to raise awareness of child physical abuse among health care professionals.

    abstract::Education is necessary to improve child physical abuse detection and management. A few studies have described national child abuse training programs, but none has measured changes in knowledge among participants. A collaboration of child abuse experts from the USA, an academic pediatric department, and a non-governmen...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s00431-020-03625-4

    authors: Soldatou A,Stathi A,Panos A,Paouri B,Koutsoukou E,Krepis P,Tsolia M,Oral R,Leventhal JM

    更新日期:2020-09-01 00:00:00

  • Vitamin B12 deficiency in a 9-month-old boy.

    abstract:UNLABELLED:We present a 9-month-old boy with megaloblastic anaemia, neutropenia and hypogammaglobulinaemia due to vitamin B12 deficiency. The deficiency was secondary to prolonged exclusive breastfeeding with inadequate nutritional amounts of vitamin B12 from the mother. There were no clinical or biological signs of ma...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s00431-011-1577-4

    authors: Quentin C,Huybrechts S,Rozen L,De Laet C,Demulder A,Ferster A

    更新日期:2012-01-01 00:00:00

  • Transient neutropenia in children with febrile illness and associated infectious agents: 2 years' follow-up.

    abstract::The aim of the study was to identify the relationship of acquired neutropenia with childhood infections and to assess its clinical course, complications, and outcome. Children admitted to two pediatric wards over a 4-year period with febrile neutropenia were prospectively investigated for underlying infections with in...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s00431-013-1965-z

    authors: Alexandropoulou O,Kossiva L,Haliotis F,Giannaki M,Tsolia M,Panagiotou IP,Karavanaki K

    更新日期:2013-06-01 00:00:00

  • Long-term follow-up after stroke in childhood.

    abstract:UNLABELLED:Over the last few years, the importance of paediatric stroke has become more and more evident; however, there is still little known about long-term neurological and especially neuropsychological outcome of these children. By retrospective chart review, questionnaire and clinical examination with structured i...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s00431-003-1357-x

    authors: Steinlin M,Roellin K,Schroth G

    更新日期:2004-04-01 00:00:00

  • High-frequency oscillatory ventilation in paediatric patients with acute respiratory distress syndrome--early rescue use.

    abstract:UNLABELLED:In order to determine the response to high-frequency oscillatory ventilation (HFOV), used as an "early rescue" therapy, in a cohort of paediatric patients with acute respiratory distress syndrome (ARDS), a prospective clinical study was performed in a tertiary care paediatric intensive care unit. Ten consecu...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s00431-004-1544-4

    authors: Ben Jaballah N,Mnif K,Bouziri A,Kazdaghli K,Belhadj S,Zouari B

    更新日期:2005-01-01 00:00:00

  • Limb hypotrophy in a child with history of umbilical cord knots. Nerve ultrasound findings.

    abstract:: ...

    journal_title:European journal of pediatrics

    pub_type: 信件

    doi:10.1007/s00431-018-3259-y

    authors: Coraci D,Giovannini S,Loreti C,Erra C,Padua L

    更新日期:2019-01-01 00:00:00

  • Variable outcome of experimental interferon-gamma therapy of disseminated Bacillus Calmette-Guerin infection in two unrelated interleukin-12Rbeta1-deficient Slovakian children.

    abstract:UNLABELLED:Mycobacterium bovis Bacillus Calmette-Guerin (BCG) is an attenuated live vaccine that may cause life-threatening clinical disease in children with impaired immunity. In particular, patients with any of the nine known inherited disorders of the interleukin-12/23 interferon-gamma (IL-12/23-IFNgamma) axis are h...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s00431-004-1599-2

    authors: Ulrichs T,Fieschi C,Nevicka E,Hahn H,Brezina M,Kaufmann SH,Casanova JL,Frecerova K

    更新日期:2005-03-01 00:00:00

  • New insights into lipid and fatty acid metabolism via stable isotopes.

    abstract:UNLABELLED:Dynamic processes are of great interest in the study of lipid and fatty acid metabolism. Their in vivo investigation is now possible with the use of stable isotope tracers and the available sensitive analytical technology. We present some examples demonstrating the assessment of lipid oxidation as well as mo...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章,评审

    doi:10.1007/pl00014276

    authors: Demmelmair H,Sauerwald T,Koletzko B,Richter T

    更新日期:1997-08-01 00:00:00

  • Successful prenatal treatment of congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

    abstract::A mother carrying a fetus affected with 21-hydroxylase deficiency received prenatal treatment with dexamethasone (0.5 mg, tid, p.o.) started from the very beginning of the 8th week of gestation. Prenatal diagnosis had to rely on amniocentesis with karyotyping and steroid hormone determination, because HLA and DNA data...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/BF02190657

    authors: Wudy SA,Homoki J,Teller WM

    更新日期:1994-08-01 00:00:00

  • Circadian growth hormone secretion in short multitransfused prepubertal children with thalassaemia major.

    abstract:UNLABELLED:Growth hormone (GH) secretion was determined by evaluating circadian GH profiles for 24 h and GH responses to clonidine stimulation test and insulin-stimulated hypoglycaemia (ITT), in nine prepubertal children with beta-thalassaemia major (TM) and 17 with non-GH deficient short stature (NGHDSS). The TM child...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/BF02029352

    authors: Katzos G,Harsoulis F,Papadopoulou M,Athanasiou M,Sava K

    更新日期:1995-06-01 00:00:00

  • Continuous negative extrathoracic pressure and cardiac output--a pilot study.

    abstract::Continuous negative extrathoracic pressure (CNEP) has been recently reintroduced as therapy for respiratory failure. To determine its effects on cardiac output a pilot study was performed in ten patients aged 2 months-3 years (median 4 months). All had chronic respiratory failure (seven with bronchopulmonary dysplasia...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/BF01954088

    authors: Raine J,Redington AN,Benatar A,Samuels MP,Southall DP

    更新日期:1993-07-01 00:00:00

  • Evaluation of growth hormone in thalassaemic boys with failed puberty: spontaneous versus provocative test.

    abstract::Growth hormone (GH) secretion was determined by evaluating ultradian GH profiles for 12 h and GH responses to insulin stimulated hypoglycaemia (ITT) in 28 stunted boys with beta-thalassaemia major aged 15.2-17.4 years, who presented with pubertal failure (FP). Healthy non thalassaemia prepubertal boys (n = 10) aged 7....

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/BF01953984

    authors: Chatterjee R,Katz M,Cox T,Bantock H

    更新日期:1993-09-01 00:00:00

  • A novel gain-of-function mutation (F821L) in the transmembrane domain of calcium-sensing receptor is a cause of severe sporadic hypoparathyroidism.

    abstract:UNLABELLED:Gain-of-function mutations of the extracellular calcium (Ca(2+)e)-sensing receptor (CaR) have been identified in patients with familial and sporadic hypercalciuric hypocalcaemia. We describe a patient with sporadic severe hypercalciuric hypocalcaemia with undetectable or very low levels of serum parathyroid ...

    journal_title:European journal of pediatrics

    pub_type: 杂志文章

    doi:10.1007/s00431-003-1331-7

    authors: Shiohara M,Mori T,Mei B,Brown EM,Watanabe T,Yasuda T

    更新日期:2004-02-01 00:00:00