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Service evaluation of laceration risk using trainer adrenaline auto-injectors
  1. Louise Charlotte Pike,
  2. David Tuthill
  1. Children's Hospital for Wales, Cardiff, UK
  1. Correspondence to Dr David Tuthill, Children's Hospital for Wales, Cardiff, Cardiff, UK; david.tuthill{at}


Objective Anaphylaxis is a severe, potentially fatal allergic reaction best treated with intramuscular epinephrine via epinephrine auto-injectors (AAIs). Our published concerns over laceration injuries to young children associated with AAIs led to this service evaluation of the two administration methods: swing and jab (S&J) and place and press (P&P), to determine potential laceration risk.

Design A trainer EpiPen was used with facepaint placed in the needle indentation which would record the length of movement of the AAI. The two different methods ‘administered’ were alternated. Children were asked to move their leg to simulate a withdrawal reaction. Age, whether they moved, and length of paint mark were recorded.

Setting Outpatients waiting area in Noah’s Ark Children’s Hospital, Cardiff.

Participants Children aged 5–11 with no prior knowledge of AAI use.

Intervention No intervention was implemented.

Results 135 children (mean age 8 years; range 5–11 years) were asked to participate; measurements were taken from 100 children. 50 children moved for one or both methods. For those that moved, S&J mean paint length=8.3 mm (SD 17.4, 95% CI 3.4 to 13.3), P&P mean=3.5 mm (SD 11.0, 95% CI 0.4 to 6.6). Mean difference between methods was 4.8 mm (SD 10.1, 95% CI 1.9 to 7.7). Slightly more children moved for S&J (44) compared with 38 for P&P.

Conclusions S&J produces more movement and longer paint marks than P&P. The risk of laceration when administering an EpiPen to young children may be lower by using the more controlled P&P. We feel it is advisable to teach P&P instead in children below 11 years of age.

  • allergy
  • injury prevention

Statistics from


  • Contributors DT derived the original idea of evaluating the two different methods after noticing and publishing a case history on a young child who had suffered a laceration from the swing and jab method. LP came up with the method of measuring laceration length, collected and then analysed the data. Both authors have had input in writing the original paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This service user evaluation was approved as a student project by Cardiff University. Ethical approval was not required as this was a non-randomised service evaluation to improve safety of the outcome of our two routine training methods for administering an epinephrine auto-injector.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All deidentified participant data are available in an online supplementary file. Please contact the author(s) for permission to reuse data from this publication:

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