RESUMO
BACKGROUND: Up to 3.5% of the population experience anaphylactic reactions in response to Hymenoptera stings. Current guidelines are in place for the diagnostic workup and follow-up care of patients with Hymenoptera venom anaphylaxis (HVA). However, little is known about the degree of implementation of the recommendations and patient attitudes toward the recommendations in the general patient population. METHODS: For the analysis of the follow-up care in real life, a retrospective questionnaire-based study was conducted in unselected patients who had received treatment from an emergency medical response team for HVA, as documented in records of three regional Medical Emergency Response Centers. RESULTS: From over 125,000 cases, a filtered list of 1895 patients that coded for anaphylaxis was generated and examination of paper records identified 548 patients with a documented insect sting anaphylaxis. Patients were sent a standardized questionnaire addressing different aspects of diagnostics and follow-up care. Almost 40% of the patients did not receive a referral to an allergist at the emergency center, over 50% did not consult an allergy specialist at any time after the index sting, 25% did not receive any form of diagnostic workup, over 30% did not receive any information about venom immunotherapy (VIT) as treatment option, and only 50% were eventually started on VIT. Emergency medication was prescribed in 90% of the cases, 77% including an adrenalin auto injector, of which 47% were expired at the time of the survey. Patients who were informed about diagnostic and treatment options early during the index event, i. e., during the stay in the emergency department, displayed a higher rate of referral to an allergist (70% vs. 17%), higher rate of diagnostic workup (88% vs. 59%), and a higher rate of initiation of VIT (89% vs. 64%), as compared to patients who did not. CONCLUSION: Our results demonstrate that there are missed opportunities for secondary and tertiary prevention of anaphylaxis due to insect venom allergy and that early information on required diagnostics and treatment options has a major impact on the degree of proper follow-up care in line with current guideline recommendations.
RESUMO
Objetivos: Descrever o perfil dos pacientes vítimas de acidente de trânsito atendidos no serviço de emergência do Hospital Nossa Senhora da Conceição, em Tubarão, SC. Métodos: Realizou-se um estudo que incluiu todos os pacientes vítimas de acidente de trânsito atendidos no serviço de emergência do Hospital Nossa Senhora da Conceição, no período de dezembro de 2010 a fevereiro de 2011.Resultados: A amostra foi constituída de 101 pacientes, com média de idade de 35,3±14,9 anos e 78,2% do sexo masculino. Os homens tiveram aproximadamente 40% mais risco de acidente com veículos motorizados do que as mulheres, sendo que a motocicleta foi o meio de transporte mais envolvido nos acidentes (74,3%). As partes do corpo mais atingidas durante os acidentes foram as extremidades (68,3%) e os principais diagnósticos foram entorse, luxação e contusão, com 44,6% dos casos. Alta hospitalar foi o desfecho para 68,3% das vítimas.Conclusões: Os resultados mostram a necessidade de medidas preventivas e de controle para um trânsito com menor risco. Essas medidas devem ser direcionadas principalmente aos jovens do sexo masculino condutores de moto-cicletas.
Aims: To describe the profile of victims of traffic accidents attended at the Emergency Service, Hospital Nossa Senhora da Conceição, in Tubarão city, Santa Catarina state, Brazil. Methods: We conducted a study that included all patients victims of traffic accidents attended at the emergency room of Hospital Nossa Senhora da Conceição, from December 2010 to February 2011. Results: The sample consisted of 101 patients, mean age 35.3±14.9 years and 78.2% male. Men had a nearly 40% greater risk of motor vehicle accident than women, and the motorcycle was the main vehicle involved in accidents (74.3%). The most affected body portions during accidents were the extremities (68.3%), and the main diagnoses were sprain, dislocation, and contusion, with 44.6% of cases. Discharge was the outcome for 68.3% of the victims. Conclusions: These results show the need for preventive measures and control for a traffic with less risk. Preventive measures should be targeted mainly at young male drivers of motorcycles.