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Factors Affecting the Administration of Epinephrine in Pediatric Anaphylaxis

Author: Eric M. Hastings | |

Associate Authors: Sean R. Daley | Bradley E. Dean | Ginny K. Renkiewicz | Michael W. Hubble

Introduction

Epinephrine administration has been proven to prevent deterioration in pediatric allergic reactions.

Objective

To predict epinephrine administration in pediatric allergic reactions and subsequent anaphylaxis.

Methods

This was a retrospective study using a nationwide dataset from the 2017 ESO Solutions dataset. The database contains prehospital patient-care records for over 5 million EMS responses from more than 900 US agencies and encompasses a broad range of practice settings. Pediatric patients with a provider primary impression of allergic reaction, anaphylaxis, or anaphylactic shock. Descriptive statistics determined the proportion of patients that received interventions specific to the management of allergic reactions. Chi-square and t-tests were used to determine significance in a univariate analysis. A multivariate logistic regression was used to determine predictors of epinephrine administration.

Results

A total of 5,819 patients met inclusionary criteria. The mean age was 9.2 (± 6.1) years, 47.8% female, 37.4% minorities, with a mean EMS response time of 9.19 (± 24.28) minutes. Overall, 17.9% received epinephrine, the most frequent administration route was intramuscular (83.1%). A multivariate logistic regression determined the likelihood of epinephrine receipt (Nagelkerke R2 = 0.24). Significant adjusted odds ratios included nonminority status (OR: 1.28, P = 0.02), receipt of diphenhydramine (Benadryl) (OR: 5.02, P < 0.001), age ≥ 8 (OR: 1.92, P < 0.001), and pediatric age-adjusted shock index (SIPA) > 0.9 (OR: 1.38, P = 0.02). Statistically significant odds ratios were also observed with increases in respiratory rate (OR: 1.02, P = 0.008) and heart rate (OR: 1.014, P < 0.001).

Conclusion

When evaluating the likelihood of receiving epinephrine, patients were 28% more likely if they were White, 5 times more likely if they received diphenhydramine, 92% more likely when age ≥ 8, and 38% more likely when SIPA was indicative of shock. Incremental increases in respiratory and heart rate were 2% and 1.4% more likely to result in epinephrine administration, respectively. Further research should explore epinephrine administration in patients under the age of 8 years.