Asia Pac Allergy.  2014 Jul;4(3):164-171. 10.5415/apallergy.2014.4.3.164.

Knowledge of anaphylaxis among Emergency Department staff

• Ibrahim I
• Chew BL
• Zaw WW
• Van Bever

• KMID: 2397094
• DOI: http://doi.org/10.5415/apallergy.2014.4.3.164

Abstract

BACKGROUND
Anaphylaxis is an emergency condition that requires immediate, accurate diagnosis and appropriate management. However, little is known about the level of knowledge of doctors and nurses treating these patients in the Emergency Department.
OBJECTIVE
To determine the knowledge of doctors and nurses in the Emergency Department on the recent definition and treatment recommendations of anaphylaxis.
METHODS
We surveyed doctors and nurses of all grades in a tertiary Hospital Emergency Department using a standardized anonymous questionnaire.
RESULTS
We had a total of 190 respondents-47 doctors and 143 nurses. The response rate was 79.7% for doctors and 75.3% for nurses. Ninety-seven point eight percent of the doctors and 83.7% of the nurses chose the accepted definition of anaphylaxis. High proportions of doctors (89-94%) and nurses (65-72%) diagnose anaphylaxis in the three scenarios demonstrating anaphylaxis and anaphylactic shock. Forty-two point six percent of the doctors and 76.9% of the nurses incorrectly diagnosed single organ involvement without hypotension as anaphylaxis. As for treatment, 89.4% of the doctors indicated adrenaline as the drug of choice and 85.1% chose intramuscular route for adrenaline administration. Among the nurses, 40.3% indicated adrenaline as the drug of choice and 47.4% chose the intramuscular route for adrenaline.
CONCLUSION
High proportion of doctors and nurses are able to recognize the signs and symptoms of anaphylaxis, although there is a trend towards over diagnosis. There is good knowledge on drug of choice and the accepted route of adrenaline among the doctors. However, knowledge of treatment of anaphylaxis among nurses was moderate and can be improved.

Keyword

Anaphylaxis; Health knowledge, attitudes, practice; Emergency service, hospital; Data collection

MeSH Terms

Anaphylaxis*
Anonyms and Pseudonyms
Data Collection
Diagnosis
Emergencies*
Emergency Service, Hospital*
Epinephrine
Health Knowledge, Attitudes, Practice
Humans
Hypotension
Tertiary Care Centers
Epinephrine

Reference

1. Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, Brown SG, Camargo CA Jr, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD Jr, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O'Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW. Second symposium on the definition and management of anaphylaxis: summary report-second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med. 2006; 47:373–380.

2. Simons FE. Anaphylaxis: recent advances in assessment and treatment. J Allergy Clin Immunol. 2009; 124:625–636.

3. Neugut AI, Ghatak AT, Miller RL. Anaphylaxis in the United States: an investigation into its epidemiology. Arch Intern Med. 2001; 161:15–21.

4. Peng MM, Jick H. A population-based study of the incidence, cause, and severity of anaphylaxis in the United Kingdom. Arch Intern Med. 2004; 164:317–319.

5. Jose R, Clesham GJ. Survey of the use of epinephrine (adrenaline) for anaphylaxis by junior hospital doctors. Postgrad Med J. 2007; 83:610–611.

6. Grossman SL, Baumann BM, Garcia Pena BM, Linares MY, Greenberg B, Hernandez-Trujillo VP. Anaphylaxis knowledge and practice preferences of pediatric emergency medicine physicians: a national survey. J Pediatr. 2013; 163:841–846.

7. Cetinkaya F, Zubarioglu AU, Goktas S. Pediatricians' knowledge about recent advances in anaphylaxis treatment in Istanbul, Turkey. Turk J Pediatr. 2009; 51:19–21.

8. Anaphylaxis: Guidelines from the European Academy of Allergy and Clinical Immunology (EAACI) [Internet]. Zurich: EAACI;c2014. cited 2014 Apr 1. Available from: http://www.eaaci.org/attachments/Anaphylaxis%20guidelines%20Draft%204.5%202013%2006%20.pdf.

9. Lieberman P, Nicklas RA, Oppenheimer J, Kemp SF, Lang DM, Bernstein DI, Bernstein JA, Burks AW, Feldweg AM, Fink JN, Greenberger PA, Golden DB, James JM, Kemp SF, Ledford DK, Lieberman P, Sheffer AL, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang D, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles S, Wallace D. The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol. 2010; 126:477–480.

10. Simons FE. World Allergy Organization. World Allergy Organization survey on global availability of essentials for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings. Ann Allergy Asthma Immunol. 2010; 104:405–412.

11. Simons FE, Ardusso LR, Dimov V, Ebisawa M, El-Gamal YM, Lockey RF, Sanchez-Borges M, Senna GE, Sheikh A, Thong BY, Worm M. World Allergy Organization. World Allergy Organization Anaphylaxis Guidelines: 2013 update of the evidence base. Int Arch Allergy Immunol. 2013; 162:193–204.

12. Lieberman P, Camargo CA Jr, Bohlke K, Jick H, Miller RL, Sheikh A, Simons FE. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol. 2006; 97:596–602.

13. Estabrooks CA, Chong H, Brigidear K, Profetto-McGrath J. Profiling Canadian nurses' preferred knowledge sources for clinical practice. Can J Nurs Res. 2005; 37:118–140.