Anaphylaxis cases presenting to primary care paramedics in Quebec

Immunity, Inflammation and Disease

Nofar Kimchi¹  Ann Clarke⁴  Jocelyn Moisan⁶  Colette Lachaine³  Sebastien La Vieille²  Yuka Asai⁷  Lawrence Joseph⁸  Chris Mill⁵ 

[1] Technion American Medical Students Program, Haifa, Israel;Food Directorate, Health Canada, Ottawa, Ontario, Canada;Directrice médicale nationale, Direction Adjointe de Services Préhospitaliers D'urgence, MSSS, Quebec, Canada;Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada;School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada;Directeur Médical Régional des Services Préhospitaliers D'urgence de L'Outaouais, Quebec, Canada;Division of Dermatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada;Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada

关键词: Anaphylaxis;    Emergency Medical Services;    epinephrine;    management;    triggers;   

DOI  :  10.1002/iid3.78

来源: Wiley

【 摘 要 】

Abstract

Data on anaphylaxis cases in pre-hospital settings is limited. As part of the Cross Canada Anaphylaxis Registry (C-CARE), we assessed anaphylaxis cases managed by paramedics in Outaouais, Quebec. A software program was developed to prospectively record demographic and clinical characteristics as well as management of cases meeting the definition of the anaphylaxis. Univariate and multivariate logistic regressions were compared to assess factors associated with severity of reactions and epinephrine use. Among 33,788 ambulance calls of which 23,486 required transport, 104 anaphylaxis cases were identified (anaphylaxis rate of 0.31% [95%CI, 0.25%, 0.37%] among all ambulance calls and 0.44% [95%CI, 0.36%, 0.54%] among those requiring transport). The median age was 46.8 years and 41.3% were males. The common triggers included food (32.7% [95%CI, 24.0%, 42.7%]), drugs (24.0% [16.4%, 33.6%]), and venom (17.3% [10.8%, 26.2%]). Among all reactions, 37.5% (95%CI, 28.4%, 47.6%) were severe. Epinephrine was not administered in 35.6% (95%CI, 26.6%, 45.6%) of all cases. Males were more likely to have severe reactions (Odds ratio [OR]: 2.50 [95%CI, 1.03, 6.01]). Venom-induced reactions and severe anaphylaxis were more likely to be managed with epinephrine (OR: 6.9 [95%CI, 1.3, 35.3] and 4.2 [95%CI, 1.5, 12.0], respectively). This is the first prospective study evaluating anaphylaxis managed by paramedics. Anaphylaxis accounts for a substantial proportion of the cases managed by paramedics in Outaouais, Quebec and exceeds prior reports of the proportion of Quebec emergency room visits attributed to anaphylaxis. Although guidelines recommend prompt use of epinephrine for all cases of anaphylaxis, more than a third of cases did not receive epinephrine. It is crucial to develop educational programs targeting paramedics to promote the use of epinephrine in all cases of anaphylaxis regardless of the specific trigger.

【 授权许可】

CC BY   
© 2015 The Authors. Immunity, Inflammation and Disease Published by John Wiley & Sons Ltd.

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