Knowledge Gap in Anaphylaxis Treatment
It was with great interest that we read the article from Sidhu et al,1 recently published in Pediatric Emergency Care, about the adherence of physicians to anaphylaxis guidelines. The knowledge of doctors about the first-line drug to treat an acute episode of anaphylaxis has been a subject of many studies,2,3 and the adherence to recent protocols has been worryingly low.
Of course, the retrospective nature of the study is a significant limitation, as stated in the article. In this way, from 1500 potential patients, only 187 were included because of record problems. How many of those patients excluded because of incomplete records, for example, would have matched the criteria for anaphylaxis? Furthermore, for the same reason, how many patients with improper International Classification of Diseases, Ninth Revision, were incorrectly excluded from the study? That could introduce a bias in the results.
Another point of interest is that antihistamines and corticosteroids were administered for a greater number of patients than epinephrine. We conclude that patients received epinephrine plus other drugs for anaphylaxis in the emergency department. What is not clear is whether the patients received antihistamines and corticosteroids first and, after therapeutic failure, epinephrine was administered afterward or whether it was administered concomitantly. That information is important because a delay in administering epinephrine, no matter that the treatment has been initiated with drugs of other therapeutic class, is related to an increased risk of fatality.4
Although knowledge translation5 may be an unfamiliar terminology to most emergency physicians, the existing gap between current best evidence and evidence-based practice is a concern, and studies to understand the learning process of emergency room physicians are necessary to clarify this issue.