Prehospital Administration of Epinephrine in Pediatric Anaphylaxis – a Statewide Perspective

Rationale: Timely administration of epinephrine is critical in the treatment of anaphylaxis.  Very little information is available on the rates of administration of epinephrine by EMS providers caring for pediatric patients in the prehospital setting.

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.