Use of epinephrine in anaphylaxis: a 6-year retrospective cohort study at a Swiss university emergency department

Abstract

Background Anaphylaxis is a medical emergency and requires prompt treatment to prevent life threatening conditions. Epinephrine considered as the first-line drug is often not administered. We aimed first to analyze the use of epinephrine in patients with anaphylaxis in the emergency department of a University Hospital and secondly to identify factors that influence the use of epinephrine. Methods We performed a retrospective analysis of all patients who were admitted with moderate or severe anaphylaxis to the emergency department between 1 January 2013 to 31 December 2018. Patient characteristics and treatment information were extracted from the electronic medical database or manually of the full emergency department discharge report. Results A total of 531 (0.2%) patients with moderate or severe anaphylaxis out of 260'485 patients admitted to the emergency department were included. Epinephrine was administered in 252 patients (47.3%). In a multivariate logistic regression cardiovascular (ORCARD = 2.94, CI 1.96–4.46, p < 0.001) and respiratory symptoms (ORRESP=3.14, CI 1.95–5.14, p < 0.001) were associated with increased likelihood of epinephrine administration, in contrast to integumentary symptoms (ORINTEGU = 0.98, CI 0.54–1.81, p = 0.961) and gastrointestinal symptoms (ORGAST=0.62, CI 0.39–1.00, p = 0.053). Conclusions Less than half of the patients with moderate and severe anaphylaxis received epinephrine according to guidelines. In particular, gastrointestinal symptoms seem to be misrecognized as serious symptoms of anaphylaxis. Training of the rescue service and emergency department medical staff and further awareness are crucial to increase the administration rate of epinephrine in anaphylaxis.