Abstract：
BACKGROUND: Anaphylaxis is an acute and serious allergic reaction. Little is known about physician adherence to anaphylaxis guidelines among patients across different age groups.
OBJECTIVE: To investigate real-world physician adherence to anaphylaxis guidelines among children, adults, and older adults in emergency departments.
METHODS: This study retrospectively analyzed all consecutive patients with anaphylaxis who presented to 2 emergency departments at 2 branches of the largest tertiary hospital in Taiwan, between 2001 and 2020. Patients who met the diagnostic criteria for anaphylaxis were enrolled and grouped by age: children (<18 years), adults (18-64 years), and older adults (≥65 years).
RESULTS: We enrolled 771 patients with anaphylaxis (159 children, 498 adults, and 114 older adults). Intramuscular epinephrine was administered in 294 cases (38.1%). There was a significant age-group difference in the rate of intramuscular epinephrine administration (46.5% in children, 37.3% in adults, and 29.8% in older adults; P trend = .004). When stratified by severity, 14.3% of older adults with moderate reactions received intramuscular epinephrine, whereas 35.2% of adults and 55.3% of children received intramuscular epinephrine (P trend < .001), whereas such difference was not found in patients with severe reactions. Upon discharge from emergency departments, 15.3% received allergist referral (52.2% in children, 6.6% in adults, and 1.8% in older adults; P trend < .001); 12.5% received education on avoidance of triggers (18.9%, 11.4%, and 7.9%; P trend = .01), and 16.1% received education on alarm symptoms (21.4%, 15.1%, and 13.2%; P trend = .05).
CONCLUSIONS: The real-world physician adherence to anaphylaxis guidelines remains suboptimal in emergency departments, particularly among older adults. Physician continuing education is needed to improve the gap between anaphylaxis guidelines and clinical practice.
OBJECTIVE: To investigate real-world physician adherence to anaphylaxis guidelines among children, adults, and older adults in emergency departments.
METHODS: This study retrospectively analyzed all consecutive patients with anaphylaxis who presented to 2 emergency departments at 2 branches of the largest tertiary hospital in Taiwan, between 2001 and 2020. Patients who met the diagnostic criteria for anaphylaxis were enrolled and grouped by age: children (<18 years), adults (18-64 years), and older adults (≥65 years).
RESULTS: We enrolled 771 patients with anaphylaxis (159 children, 498 adults, and 114 older adults). Intramuscular epinephrine was administered in 294 cases (38.1%). There was a significant age-group difference in the rate of intramuscular epinephrine administration (46.5% in children, 37.3% in adults, and 29.8% in older adults; P trend = .004). When stratified by severity, 14.3% of older adults with moderate reactions received intramuscular epinephrine, whereas 35.2% of adults and 55.3% of children received intramuscular epinephrine (P trend < .001), whereas such difference was not found in patients with severe reactions. Upon discharge from emergency departments, 15.3% received allergist referral (52.2% in children, 6.6% in adults, and 1.8% in older adults; P trend < .001); 12.5% received education on avoidance of triggers (18.9%, 11.4%, and 7.9%; P trend = .01), and 16.1% received education on alarm symptoms (21.4%, 15.1%, and 13.2%; P trend = .05).
CONCLUSIONS: The real-world physician adherence to anaphylaxis guidelines remains suboptimal in emergency departments, particularly among older adults. Physician continuing education is needed to improve the gap between anaphylaxis guidelines and clinical practice.
摘要：
背景：过敏反应是一种急性和严重的过敏反应。在不同年龄段的患者中，医生对过敏反应指南的依从性知之甚少。
目的：调查真实世界医生对儿童过敏反应指南的依从性，成年人,和急诊室的长者。
方法：本研究回顾性分析了台湾最大的三级医院的两个分支机构的两个急诊科连续出现过敏反应的所有患者，从2001年到2020年。符合过敏反应诊断标准的患者被纳入并按年龄分组：儿童（<18岁），成人（18-64岁）和老年人（≥65岁）。
结果：我们招募了771名过敏反应患者（159名儿童，498名成人和114长者）。294例（38.1％）肌内注射肾上腺素。肌内肾上腺素给药率在年龄组上有显著差异(儿童为46.5%,成人占37.3%，老年人为29.8%；p趋势=0.004）。当按严重程度分层时，14.3%中度反应的长者接受肌内注射肾上腺素,而35.2%的成人和55.3%的儿童接受了肌内肾上腺素(p_trend<.001),而这种差异在严重反应的患者中没有发现。从急诊科出院后，15.3%的人接受了过敏症专科医生转诊(52.2%的儿童，6.6%的成年人，和1.8%的老年人；p_trend<.001)；12.5%的人接受了避免触发因素的教育(18.9%，11.4%,7.9%；p_trend=0.01)和16.1%接受了警报症状教育(21.4%，15.1%,和13.2%；p趋势=0.05）。
结论：在急诊科，真实世界的医生对过敏反应指南的依从性仍然不够理想，尤其是在长辈中。需要医师继续教育来改善过敏反应指南与临床实践之间的差距。
目的：调查真实世界医生对儿童过敏反应指南的依从性，成年人,和急诊室的长者。
方法：本研究回顾性分析了台湾最大的三级医院的两个分支机构的两个急诊科连续出现过敏反应的所有患者，从2001年到2020年。符合过敏反应诊断标准的患者被纳入并按年龄分组：儿童（<18岁），成人（18-64岁）和老年人（≥65岁）。
结果：我们招募了771名过敏反应患者（159名儿童，498名成人和114长者）。294例（38.1％）肌内注射肾上腺素。肌内肾上腺素给药率在年龄组上有显著差异(儿童为46.5%,成人占37.3%，老年人为29.8%；p趋势=0.004）。当按严重程度分层时，14.3%中度反应的长者接受肌内注射肾上腺素,而35.2%的成人和55.3%的儿童接受了肌内肾上腺素(p_trend<.001),而这种差异在严重反应的患者中没有发现。从急诊科出院后，15.3%的人接受了过敏症专科医生转诊(52.2%的儿童，6.6%的成年人，和1.8%的老年人；p_trend<.001)；12.5%的人接受了避免触发因素的教育(18.9%，11.4%,7.9%；p_trend=0.01)和16.1%接受了警报症状教育(21.4%，15.1%,和13.2%；p趋势=0.05）。
结论：在急诊科，真实世界的医生对过敏反应指南的依从性仍然不够理想，尤其是在长辈中。需要医师继续教育来改善过敏反应指南与临床实践之间的差距。
