Outcomes associated with prehospital epinephrine in adult and pediatric patients with anaphylaxis.

BACKGROUND: Prompt epinephrine administration is important to improve outcomes in anaphylaxis. OBJECTIVE: To assess the impact of prehospital epinephrine on clinical outcomes of hospital admission, biphasic reactions, and emergency department (ED) length of stay (LOS) in a cohort of ED patients who had anaphylaxis including both children and adults. METHODS: We conducted a single-center prospective and retrospective cohort study of patients who had anaphylaxis from April 2008 to December 2022. Associations between prehospital epinephrine administration with biphasic reactions and ED LOS were assessed with univariable models and the association with ED disposition was assessed with both univariable and multivariable logistic regression. RESULTS: A total of 1107 patient visits were included for analysis. The median patient age was 29 (IQR: 14-50), 593 (53.6%) patients were of female sex, and 366 (33.1%) were younger than 18 years of age. Patients in the prehospital epinephrine group were also less likely to experience a biphasic reaction (5.4% vs 9.3%; odds ratio [OR] 0.56, 95% CI: 0.34-0.92) and had a decreased ED LOS (median 4.0 hours vs 4.7 hours). There was no difference in hospital admission between patients with and without prehospital epinephrine in both the univariable (19.5% vs 15.7%; OR 1.30, 95% CI: 0.94-1.79) and multivariable (adjusted OR 1.08, 95% CI: 0.71-1.64) models. CONCLUSION: Prehospital epinephrine administration reduced the odds of a biphasic reaction and decreased ED LOS but did not reduce hospitalization in this cohort of ED patients who had anaphylaxis. Our findings suggest that timely administration of prehospital epinephrine is associated with improved patient outcomes.

Association between school learning models and psychological and social health visits to the emergency room.

Objectives: We aimed to assess the impact of in-person and distance school learning models on children's visits to the emergency department (ED) for psychological or social ("psychosocial") complaints. Methods: We analyzed presentations to one emergency department in a mid-sized Midwestern city. We used the public school system schedule to determine in-person and distance learning periods by the grade level. We calculated the incidence of visits to the emergency department during academic years 2018-2019, 2019-2020, and 2020-2021, with particular attention to the time after March 13, 2020, which was the pandemic period. We compared the incidence of visits during in-person versus distance learning school models. Results: A total of 7181 visits occurred during the academic years studied, 17.1% due to psychosocial complaints. The incidence of psychosocial visits to the ED was lower during distance learning than during the pandemic in-person learning period (given per 1000 student years: 20.5 vs. 24.1, p = 0.14). This difference was statistically significant among middle schoolers (23.3 vs. 46.6, p < 0.001). While not statistically significant, the difference among high schoolers was pragmatically relevant (38.2 vs. 49.3, p = 0.086). Conclusions: Distance learning was associated with a decrease in the incidence of psychosocial visits to the emergency department relative to in-person learning. Future investigation is required to verify results and better understand any causative relationships.