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Abstract
Anaphylaxis is a severe, life-threatening hypersensitivity reaction. NICE issued guidance in December 2011 regarding management of suspected anaphylaxis, the authors of which attribute suboptimal management to inadequate understanding by health care professionals.
Aim We aim to evaluate how suspected anaphylaxis was managed in a large NHS trust and to assess knowledge of trainees and final year medical students.
Method A retrospective case note analysis of patients under 17 years old coded with anaphylaxis between January 2007 and September 2012 comparing management to NICE guidance, was performed. This was supplemented by a survey (based on Advanced Paediatric Life Support guidelines) of junior doctors and medical students. Participants assigned twenty clinical features to ‘allergy’, ‘suspected anaphylaxis’ or’ neither’ and selected suitable management options.
Results Table 1 illustrates initial management of anaphylaxis in 71 analysed cases.
NICE provides guidance regarding discharge, compliance with which is highlighted in table 2. 66% of children had a known allergy; 72% of which were admitted with a reaction to their known allergen. 55% of children known to carry an adrenaline autoinjector used it correctly on this occasion.
The results of the survey are shown in table 3. Anaphylaxis recognition was poorer amongst Emergency Medicine trainees compared with General Practice and Paediatric trainees. Regarding management, lower scores were seen in the more senior paediatric trainees and general practise trainees.
Conclusions Our results identify aspects of good practise but also areas for improvement, especially regarding discharge information. The proportion of children being admitted with anaphylaxis to a known allergen and incorrect use of their autoinjector suggests a need to improve education. This project demonstrates that lack of trainee knowledge translates into clinical reality. We believe that improving trainee knowledge is vital in improving the management of anaphylaxis and as well as enabling doctors to educate patients and relatives.
References
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Pumphrey RS (2000) Clinical and Experimental Allergy 30(8): 1144–50.
National Institute for Health and Clinical Excellence (2011) Anaphylaxis. CG134. London.
Advanced Life Support Group. Advanced Paediatric Life Support (APLS), Fifth Edition. Blackwell 2011.
