Study: Emergency room anaphylaxis observation times could be reduced

(Press-News.org) According to a new national study, most children visiting hospital emergency departments with anaphylaxis, a severe and potentially life-threatening allergic reaction, could be discharged after two hours or less—which is half the time of current minimum guidelines. This research will be presented at the 2023 Pediatric Academic Societies (PAS) Meeting, held April 27-May 1 in Washington, D.C.

Researchers conducted a study of 4,735 children aged 6 months to 18 years who had anaphylaxis and received at least one dose of epinephrine in the pre-emergency department or emergency department setting between 2015 and 2019.

The study suggests current national guidelines could be updated to require only two hours of observation for patients without cardiovascular symptoms. The existing guidance recommends a four- to six-hour observation period after anaphylaxis. Among the study group, researchers found patients with no respiratory or cardiovascular symptoms may be able to be discharged after only 5 minutes; patients with respiratory symptoms could be discharged after 1 hour; and patients with cardiovascular symptoms could be discharged after two hours.

“Data to back up current guidelines for anaphylaxis observation times is severely lacking, leading to inefficient care, emergency department overcrowding, and inconvenience for patients and families,” said Tim Dribin, M.D., associate professor of emergency medicine at Cincinnati Children’s Hospital Medical Center and presenting author. “Our analysis shows there is a way to safely streamline care and give crucial time and resources back to patients, families, and providers.”

The study authors note additional research is needed before the findings can be implemented in a clinical setting.

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EDITOR:

Dr. Dribin will present “Optimizing Anaphylaxis Observation Periods Based on Reaction Severity: a 30-Center Retrospective Cohort Study” on Saturday, April 29 at 2 p.m. ET.

Reporters interested in an interview with Dr. Dribin should contact Amber Fraley at amber.fraley@pasmeeting.org.

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting is the premier North American scholarly child health meeting. The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit www.pas-meeting.org. Follow us on Twitter @PASMeeting and like us on Facebook PASMeeting.

Abstract

Optimizing anaphylaxis observation periods based on reaction severity: a 30-center retrospective cohort study

Presenting Author

Tim Dribin, M.D.  

Organization

Cincinnati Children’s Hospital Medical Center

Topic

Emergency Medicine: All Areas

Background

National guidelines recommend 4–6-hour emergency department (ED) observation periods after anaphylaxis. However, data supporting this recommendation is lacking, contributing to inconsistent care, potentially unnecessarily long observation periods, ED overcrowding, and inconvenience for patients/families.

Objective

We sought to develop optimal anaphylaxis observation periods based on reaction severity.

Design/Methods

We conducted a retrospective cohort study across 30 North American EDs belonging to the Pediatric Emergency Medicine Collaborative Research Committee. Patients 6 months to < 18 years of age were eligible if they had anaphylaxis, received epinephrine in the pre-ED or ED setting, and presented for care between October 2015 - December 2019. Encounters with unrecorded time of first or last epinephrine administration were excluded. Kaplan-Meier analyses were used to assess the timing from first to last epinephrine dose based on initial ED reaction severity: a) all patients, b) no respiratory or cardiovascular (CV) involvement, c) respiratory but no CV involvement, and d) CV involvement. The optimal length of observation was determined as a < 2% increase in the cumulative risk of receiving additional epinephrine as the observation time increased by 1 hour. 

Results

We analyzed 4,735 patients. The median patient age was 7.6 years (IQR 3.1, 12.9) and the most common reaction trigger was foods (71.7%); the etiology was unknown in 18.6% of cases (see Table). 92.5% of patients were treated with 1 dose of epinephrine, 6.2% with 2 doses, and 1.3% with 3 or more doses. Optimal lengths of observation were a) 65 minutes for all patients, b) 5 minutes for patients without respiratory or CV involvement, c) 65 minutes for children with respiratory but no CV involvement, and d) 120 minutes for patients with CV involvement (see Figure).

Conclusion(s)

Our findings suggest that for patients without CV involvement, anaphylaxis observation periods of 2 hours or potentially less are safe. Prospective validation of these findings is needed before they can be applied in clinical practice.

Table Abstract 1.PNG

 

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