G69(P) Anaphylaxis pathway: A road “Tryp-tase” to success?

Abstract

AimsAnaphylaxis is a life threatening condition with a UK incidence increasing by over 6 fold between 1992–2012. Our aims were to assess the compliance of anaphylaxis management in children presenting to our Emergency Department against national guidance and to compare with our results pre the introduction of an anaphylaxis guideline locally in 2012.MethodsWe retrospectively reviewed Emergency Department attendances from April 2014–September 2015. Clinical records with a discharge code of “Anaphylaxis” were examined and compared against results from April 2012–March 2014.ResultsA total of 24 cases were identified in the first analysis and 18 in the second. Features of the acute reaction were well documented (Figure 1.) The time and circumstances around the reactions are illustrated in Figure 2. Nuts were a common trigger.Absract G69(P) Figure 1Documentation of features of an acute reactionAbsract G69(P) Figure 2Documentation of circumstances surrounding the reactionPharmacological management is illustrated in Figure 3. An initial mast cell tryptase was taken in 4 cases; it was indicated in 2 and repeated in 1; similar to previously.Absract G69(P) Figure 3Pharmacological management70% of children in the first analysis and 89% in the second were given an adrenaline auto-injector. 75% had documented evidence of how to use it compared to 82% in the re-audit. No additional children were identified as needing a device compared to 17% previously.41% and 39% of parents were given advice about the signs and symptoms of an anaphylactic reaction in the first and second subgroups respectively. No parents in either group were given information about biphasic reactionsConclusionAlthough standards are high with regards to the acute management of anaphylaxis, areas which have improved include documentation around the time and circumstance of the reaction and therefore identifying the trigger; decreasing the need for blood tests through the use of a mast cell tryptase. Areas for improvement include the use of mast cell tryptase and documenting advice to parents.Overall there is good adherence to published guidance, the introduction of a local guideline has improved results, simple measures such as patient information leaflets and personal action plans are an important step to provide consistency and education.