Table 3 Management of pediatric anaphylaxis patients
From: Downstream consequences of diagnostic error in pediatric anaphylaxis
Overall (n = 211) n(%) | ED Dx anaphylaxis (n = 105) n(%) | ED NOT Dx anaphylaxis (n = 106) n(%) | Odds ratio (95% CI) | P value | |
|---|---|---|---|---|---|
Pre hospital | |||||
Epinephrine Auto injector | 51 (24.2) | 37 (35.2) | 14 (13.2) | 3.58 (1.8–7.21) | < 0.001 |
Antihistamine | 99 (46.9) | 53 (50.5) | 46 (43.4) | 1.33 (0.78–2.28) | 0.34 |
Steroid | 22 (10.4) | 13 (12.4) | 9 (8.5) | 1.52 (0.6–3.63) | 0.38 |
Ambulance treatment (n = 106) | |||||
Epinephrine | 22 (20.8) | 21/66 (31.8) | 1/40 (2.5) | 19.05 (3.0–202.6) | 0.0001 |
Nebulized epinephrine | 2 (1.9) | 1/66 (1.5) | 1/40 (2.5) | 0.6 (0.03–11.67) | 1.000 |
Oxygen | 12/106 (11.3) | 12/66 (18.2) | 0/40 (0) | ∞ (2.6 – ∞) | 0.003 |
Beta agonist | 14/106 (13.2) | 12/66 (18.2) | 2/40 (5) | 4.38 (0.97–20.4) | 0.074 |
Steroids | 8/106 (7.5) | 6/66 (9.1) | 2/40 (5) | 1.9 (0.44–9.59) | 0.71 |
Fluids | 3/106 (2.8) | 3/66 (4.5) | 0/40 (0) | ∞ (0.52 - ∞) | 0.29 |
ED treatment | |||||
Epinephrine | 48 (22.7%) | 31 (29.5%) | 17(16.0%) | 2.20 (1.13–4.27) | 0.02 |
Nebulized epinephrine | 11 (5.2%) | 8 (7.6%) | 3 (2.8%) | 2.8 (0.73–11.00) | 0.13 |
Epinephrine infusion | 2 (0.9%) | 1 (1.0%) | 1 (0.9%) | 1.01 (0.06–16.37) | 1 |
Steroid | 97 (46.0%) | 45 (42.9%) | 52 (49.1%) | 0.78 (0.45–1.34) | 0.41 |
H1 antihistamine | 100 (47.4%) | 43 (41.0%) | 57 (53.8%) | 0.60 (0.35–1.03) | 0.07 |
H2 Antihistamine (Ranitidine) | 3 (1.4%) | 3 (2.9%) | 0 (0%) | 7.27 (0.37–142.67) | 0.12 |
Oxygen | 9 (4.3%) | 6 (5.7%) | 3 (2.8%) | 2.08 (0.51–8.55) | 0.33 |
Inhaled beta agonist | 17 (8.1%) | 9 (8.6%) | 8 (7.5%) | 1.15 (0.43–3.10) | 0.81 |
Intubation | 1 (0.5%) | 0 (0%) | 1 (0.0%) | 0.33 (0.01–8.28) | 1 |
IV fluids 1st hour | 7 (3.3%) | 6 (5.7%) | 1 (0.9%) | 6.3 (0.75–53.82) | 0.07 |
IV fluids in 24 h | 8 (3.8%) | 6 (5.7%) | 2 (1.9%) | 3.15 (0.62–15.99) | 0.17 |
Overall management | |||||
Epinephrine | 123 (58.3%) | 90 (85.7%) | 33 (31.1%) | 13.27 (6.69–26.3) | < 0.001 |
1 dose | 104 (49.3%) | 75 (71.4%) | 29 (27.4%) | N/A | < 0.001 |
2 doses | 16 (7.6%) | 12 (11.4%) | 4 (3.8%) | ||
3 doses | 3 (1.4%) | 3 (2.9%) | 0 (0%) | ||
H1 Antihistamine | 172 (81.5%) | 84 (80.0%) | 88 (83.0%) | 0.82 (0.41–1.64) | 0.60 |
Steroid | 117 (55.5%) | 57 (54.3%) | 60 (56.6%) | 0.91 (0.53–1.57) | 0.78 |