Methods: We examined data from the NC EMS database (PreMIS) from 2010-2013 to determine rates of epinephrine administration in pediatric patients with anaphylaxis. We studied patients <18 years of age with an EMS provider impression of “allergic reaction.” Anaphylaxis was present if there was hypotension (defined as SBP <90 or DBP <45 for patients age 11 and older, and SBP <70 + (2 x age) for patients ages 0-10), or impaired respirations (defined as description of labored or absent respirations, or RR <12 or >30). We determined the overall rate of epinephrine administration. A multivariate logistic regression was then constructed to examine the impact of the following variables on appropriate epinephrine administration: age <7, non-white race, rural county of case origin, duration of transportation from scene, and presence of a paramedic.
Results: 504 patients met inclusion criteria, of which 471 demonstrated anaphylaxis as defined above. 157 patients received epinephrine (33.3%, 95% CI 29-38%). Age <7 was associated with increased odds of not receiving epinephrine appropriately (OR 3.36, 95% CI 2.14-5.27, p <0.001). Other variables did not have statistically significant impact on epinephrine administration.
Conclusions: There are missed opportunities for prehospital administration of epinephrine in pediatric patients with anaphylaxis. Very young children (age <7) had increased odds of not receiving epinephrine.