Underuse of Epinephrine for Pediatric Anaphylaxis Victims in the Emergency Department: A Population-based Study
Underuse of Epinephrine for Pediatric Anaphylaxis Victims in the Emergency Department: A Population-based Study
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DOI：
10.4168/aair.2019.11.4.529
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发表时间：
2019-07-01
影响因子：
4.4
通讯作者：
Park, Joong Wan
中科院分区：
文献类型：
--
作者：
Choi, Yoo Jin;Kim, Joonghee;Park, Joong Wan
目的：肾上腺素是治疗过敏反应的关键药物;然而，其使用不足仍然是全球范围内的一个重大问题。本研究的目的是比较肾上腺素的使用之间的儿童和成人患者谁是治疗过敏性反应在急诊科（艾德）。方法：数据来自韩国的国家样本队列，其中包含索赔数据从国家健康保险服务。我们纳入了2004年至2013年期间因过敏性反应出院的患者，这些患者在艾德就诊。我们评估了肾上腺素，抗组胺药和全身性类固醇，既往病史和出院处置ED. The研究人群的处方信息进行了分类，根据年龄在visit.Results：共175名儿童和1,605名成人过敏反应患者被确定。仅42例（24%）儿童患者接受肾上腺素治疗，而592例（36.9%）成人患者接受肾上腺素治疗（P= 0.001）。此外，儿童患者接受全身性类固醇治疗的可能性低于成人患者（6.9% vs. 12.3%，P= 0.047）。在19-65岁年龄组中，肾上腺素给药相对于基线的比值比为0.34（95%置信区间[CI]，0.15-0.67），0.56（95% CI，0.28-1.03）和0.79（95%CI，0.45-1.33）分别在< 7岁、7-12岁和13-18岁年龄组中。发生过敏反应的儿科患者的肾上腺素注射使用率低于成人患者，且注射使用率随着年龄的降低而降低。
Purpose: Epinephrine is a key drug for treating anaphylaxis; however, its underuse is still a significant issue worldwide. The objective of this study was to compare epinephrine use between pediatric and adult patients who were treated with anaphylaxis in the emergency department (ED).Methods: The data were retrieved from the National Sample Cohort of South Korea, which contains claim data from the National Health Insurance Service. We included patients who visited the ED with a discharge code of anaphylaxis between 2004 and 2013. We assessed prescription information of epinephrine, antihistamine and systemic steroid, previous medical history and discharge disposition from the ED. The study population was categorized based on age at the visit.Results: A total of 175 pediatric and 1,605 adult patients with anaphylaxis were identified. Only 42 (24%) of the pediatric patients were treated with epinephrine, while 592 (36.9%) of the adult patients were treated with epinephrine (P= 0.001). Furthermore, the pediatric patients were less likely to be treated with systemic steroid than the adult patients (6.9% vs. 12.3%, P= 0.047). The odds ratios for the administration of epinephrine relative to the baseline in the 19-65 age group were 0.34 (95% confidence interval [CI], 0.15-0.67), 0.56 (95% CI, 0.28-1.03) and 0.79 (95% CI, 0.45-1.33) in the < 7, 7-12 and 13-18 age groups, respectively.Conclusions: The pediatric patients with anaphylaxis experienced a lower rate of epinephrine injection use than the adult patients and the injection use decreased as age decreased.