Advertisement

Internal and Emergency Medicine

, Volume 14, Issue 1, pp 127–132 | Cite as

In situ simulation in the management of anaphylaxis in a pediatric emergency department

  • Simona Barni
  • Francesca Mori
  • Mattia Giovannini
  • Marco de Luca
  • Elio Novembre
EM - ORIGINAL

Abstract

Anaphylaxis is a potentially life-threatening, rapid-onset hypersensitive reaction, usually treated in the emergency department (ED). Failure to recognize anaphylaxis leads to under-treatment with epinephrine and even when correctly diagnosed, epinephrine is not always administered. In addition, often patients who are treated in the ED are not referred for allergy work-up. Simulation is a tool that increases exposure to events in a safe environment, allowing trainers to develop skills without harming patients. The main purpose of our study was to determine whether in situ simulation training increases the frequency of epinephrine use. The secondary aim was to observe whether simulation modifies the number of children investigated over the years before and after the setting up of the simulation training. All patients with anaphylaxis referred to the Pediatric Emergency Department (PED) of the Anna Meyer Children’s Hospital from 2004 to 2010 [pre-simulation (PRE-s) period], and from 2011 to 2016 [post-simulation (POST-s) period], were retrospectively included in this observational study. Simulation was carried out using a high-fidelity patient simulator mannequin (SimBaby, Laerdal Medical, Inc, Stavanger, NY). The diagnosis of anaphylaxis was based on the EAACI guidelines. The use of epinephrine significantly increased (p < 0.05) between the PRE-s and POST-s time periods: 2.4% versus 10% patients, respectively. During the two time periods, we also observed a significant increase (p = 0.011) in the number of patients who underwent a complete allergy work-up: 36% versus 51% patients, respectively. According to our results, the in situ simulation program improved the correct management of anaphylaxis in terms of prompt use of epinephrine, and it also led to a higher number of patients being referred to the allergy unit for evaluation.

Keywords

Anaphylaxis Children Epinephrine In situ simulation Pediatric emergency department 

Notes

Compliance with ethical standards

Conflict of interest

The authors do not have conflicts of interest to declare.

Statement of human and animal rights

This study has been approved by the local ethic committee.

Informed consent

Informed consent was obtained from all participants included in the study.

References

  1. 1.
    Bohlke K, Davis RL, DeStefano F et al (2004) Epidemiology of anaphylaxis among children and adolescents en- rolled in a health maintenance organization. J Allergy Clin Immunol 113(3):536–542CrossRefGoogle Scholar
  2. 2.
    Grabenhenrich LB, Dölle S, Moneret-Vautrin A et al (2016) Anaphylaxis in children and adolescents: the European anaphylaxis registry. J Allergy Clin Immunol 137(4):1128–1137CrossRefGoogle Scholar
  3. 3.
    Motosue MS, Bellolio MF, Van Houten HK, Shah ND, Campbell RL (2017) Increasing emergency department visits for anaphylaxis, 2005–2014. J Allergy Clin Immunol Pract 5(1):171–175CrossRefGoogle Scholar
  4. 4.
    Mullins RJ, Wainstein BK, Barnes EH et al (2016) Increases in anaphylaxis fatalities in Australia 1997–2013. Clin Exp Allergy 46(8):1099–1110CrossRefGoogle Scholar
  5. 5.
    Boyce JA, Assa’ad A, Burks AW et al (2010) NIAID- sponsored expert panel. guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 126(6 Suppl):S1–S58Google Scholar
  6. 6.
    World Health Organization (2011) The selection and use of essential medicines. World Health Org Tech Rep Ser 965:1–249Google Scholar
  7. 7.
    Ross MP, Ferguson M, Street D et al (2008) Analysis of food-allergic and anaphylactic events in the national electronic injury surveillance system. J Allergy Clin Immunol 121:166–171CrossRefGoogle Scholar
  8. 8.
    Campbell RL, Hagan JB, Manivannan V et al (2012) Evaluation of national institute of allergy and infection disease/food allergy & anaphylaxis Network criteria for the diagnosis of anaphylaxis in emergency department patients. J Allergy Clin Immunol 129:748–752 ((IIb)) CrossRefGoogle Scholar
  9. 9.
    Clark S, Long AA, Gaeta TJ, Camargo CA (2005) Multicenter study of emergency department visits for insect sting allergies. J Allergy Clin Immunol 116:643–649 ((IIb)) CrossRefGoogle Scholar
  10. 10.
    Mehl A, Wahn U, Niggemann B (2005) Anaphylactic reactions in children—a questionnaire-based survey in Germany. Allergy 60:1440–1445CrossRefGoogle Scholar
  11. 11.
    Campbell RL, Luke A, Weaver AL et al (2008) Prescriptions for self-injectable epinephrine and follow-up referral in emergency department patients presenting with anaphylaxis. Ann Allergy Asthma Immunol 101:631–636CrossRefGoogle Scholar
  12. 12.
    Bock SA, Munoz-Furlong A, Sampson HA (2007) Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol 119(4):1016–1018CrossRefGoogle Scholar
  13. 13.
    Huang F, Chawla K, Järvinen KM, Nowak-Wegrzyn A (2012) Anaphylaxis in a New York city pediatric emergency department: triggers, treatments, and outcomes. J Allergy Clin Immunol 129:162–168CrossRefGoogle Scholar
  14. 14.
    Bradley P (2006) The history of simulation in medical education and possible future directions. Med Educ 40:254–262CrossRefGoogle Scholar
  15. 15.
    Tjomsland N, Baskett P, Laerdal AS (2002) Resuscitation 53:115–119CrossRefGoogle Scholar
  16. 16.
    Brockow K, Schallmayer S, Beyer K et al (2015) Effects of a structured educational intervention on knowledge and emergency management in patients at risk for anaphylaxis. Allergy 70:227–235CrossRefGoogle Scholar
  17. 17.
    Kennedy JL, Jones SM, Porter N et al (2013) High-fidelity hybrid simulation of allergic emergencies demonstrates improved preparedness for office emergencies in pediatric allergy clinics. J Allergy Clin Immunol Pract 1(6):608–617CrossRefGoogle Scholar
  18. 18.
    Shelton R (2009) The emergency severity index 5-level triage system. Dimens Crit Care Nurs 28:9–12CrossRefGoogle Scholar
  19. 19.
    Muraro A, Roberts G, Worm M et al (2014) Anaphylaxis: guidelines from the European academy of allergy and clinical immunology. Allergy 69(8):1026–1045CrossRefGoogle Scholar
  20. 20.
    Weinstock PH, Kappus LJ, Garden A, Burns JP (2009) Simulation at the point of care: reduced-cost, in situ training via a mobile cart. Pediatr Crit Care Med 10:176–181CrossRefGoogle Scholar
  21. 21.
    Rudolph JW, Simon R, Dufresne RL, Raemer DB (2006) There’s no such thing as ‘‘nonjudgmental’’ debriefing: a theory and method for debriefing with good judgment. Simul Healthc 1:49–55 (Spring) CrossRefGoogle Scholar
  22. 22.
    Alvarez-Perea A, Ameiro B, Morales C, Zambrano G, Rodríguez A, Guzmán M, Zubeldia JM, Baeza ML (2017) Anaphylaxis in the pediatric emergency department: analysis of 133 cases after an allergy workup. J Allergy Clin Immunol Pract 5:1256–1263CrossRefGoogle Scholar
  23. 23.
    Ben-Shoshan M, La Vieille S, Eisman H, Alizadehfar R, Mill C, Perkins E et al (2013) Anaphylaxis treated in a Canadian pediatric hospital: incidence, clinical characteristics, triggers, and management. J Allergy Clin Immunol 132:739–741CrossRefGoogle Scholar
  24. 24.
    Simons FE, Ebisawa M, Sanchez-Borges M et al (2015) 2015 update of the evidence base: world allergy organization anaphylaxis guidelines. World Allergy Organ J 8(1):32CrossRefGoogle Scholar
  25. 25.
    Worm M, Eckermann O, Dolle S et al (2014) Triggers and treatment of anaphylaxis: an analysis of 4,000 cases from Germany, Austria and Switzerland. Dtsch Arztebl Int 111(21):367–375 (24) Google Scholar
  26. 26.
    Russell WS, Farrar JR, Nowak R et al (2013) Evaluating the management of anaphylaxis in US emergency departments: guidelines vs. practice. World J Emerg Med 4(2):98–106CrossRefGoogle Scholar
  27. 27.
    Simons KJ, Simons FE (2010) Epinephrine and its use in anaphylaxis: current issues. Curr Opin Allergy Clin Immunol 10(4):354–361CrossRefGoogle Scholar
  28. 28.
    Sheikh A, Ten Broek V, Brown SG, Simons FE (2007) H1-antihistamines for the treatment of anaphylaxis: cochrane systematic review. Allergy 62(8):830–837CrossRefGoogle Scholar
  29. 29.
    Choo KJ, Simons E, Sheikh A (2010) Glucocorticoids for the treatment of anaphylaxis: cochrane systematic review. Allergy 65(10):1205–1211CrossRefGoogle Scholar
  30. 30.
    Hernandez L, Papalia S, Pujalte G (2016) Anaphylaxis. Prim Care Clin Office Pract 43:477–485CrossRefGoogle Scholar
  31. 31.
    Beyer K, Eckermann O, Hompes S, Grabenhenrich L, Worm M (2012) Anaphylaxis in an emergency setting—elicitors, therapy and incidence of severe allergic reactions. Allergy 11:1451–1456 (67) CrossRefGoogle Scholar
  32. 32.
    Alvarez-Perea A, Tomás-Pérez M, Martínez-Lezcano P et al (2015) Anaphylaxis in adolescent/adult patients treated in the emergency department: differences between initial impressions and the definitive diagnosis. J Investig Allergol Clin Immunol 25:288–294Google Scholar
  33. 33.
    Campbell RL, Park MA, Kueber MA, Lee S, Hagan JB (2015) Outcomes of allergy/immunology follow-up after an emergency department evaluation for anaphy- laxis. J Allergy Clin Immunol Pract 3:88–93CrossRefGoogle Scholar
  34. 34.
    Patterson MD, Geis GL, Falcone RA, LeMaster T, Wears RL (2013) In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf 22(6):468–477CrossRefGoogle Scholar
  35. 35.
    Brazil V (2017) Translational simulation: not ‘where?’ But ‘why?’ a functional view of in situ simulation. Adv Simul 2:20CrossRefGoogle Scholar

Copyright information

© SIMI 2018

Authors and Affiliations

  1. 1.Allergy Unit, Department of PediatricsAnna Meyer Children’s University HospitalFlorenceItaly
  2. 2.Simulation and Risk Management UnitAnna Meyer Children’s University HospitalFlorenceItaly

Personalised recommendations