Journal List > Allergy Asthma Respir Dis > v.4(2) > 1059167

Seo, Ye, Kim, Ban, Kim, Shin, Park, and Lee: A single hospital survey of anaphylaxis awareness among health care providers and medical students

Abstract

Purpose

Anaphylaxis is a rapidly progressive allergic reaction that requires precise recognition and immediate management. However, health care providers, awareness of anaphylaxis has not been acknowledged. The aim of this study is to investigate the extent of knowledge and principal management skills on anaphylaxis among medical personnel and students.

Methods

We performed a questionnaire survey on knowledge, education, and managing skills for anaphylaxis to physicians, nurses, health personnel, and medical students in Ajou University Medical Center, from 26 June to 31 October, 2014. The survey contained 2 main sections: questions about demographic data and 2 types of questionnaire (type I for all participants and type II for only medical staffs) for self-assessment on anaphylaxis.

Results

A total of 1,615 participants (128 doctors, 828 nurses, 436 students, and 223 health personnel) completed the survey. For questionnaire I, the percentages of correct answers in doctors, nurses, medical students, and health personnel were 77.5%, 56.4%, 47.8%, and 28.0% respectively, showing significant differences between groups (P<0.001). For questionnaire II, 93% of doctors and 75.6% of nurses indicated epinephrine as the drug of choice, and 79.7% of doctors and 71.3% of nurses selected the correct intramuscular route. More than 3 quarters of the doctors (80.5%) selected epinephrine within the first 5 steps of treatment, but only 48% included epinephrine within the first 3 steps.

Conclusion

Our study showed considerable lack of knowledge on anaphylaxis among health care providers, especially on the specific management steps of anaphylaxis. As significant gaps on overall knowledge of anaphylaxis were observed between different groups of medical personnel, regular education should be implemented for each department in the health care setting.

Figures and Tables

Fig. 1

The percentages of medical staffs who included epinephrine within essential steps of management of anaphylaxis.

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Fig. 2

The percentages of correct answers to questionnaire I in each group.

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Table 1

Demographic data

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Variable Doctor (n = 128) Nurse (n = 828) Student (n = 436) Health personnel (n = 223)
Age (yr) 32.9 ± 6.8 31.3 ± 6.3 24.4 ± 3.7 38.4 ± 10
Sex
 Male 77 (60.2) 27 (3.3) 209 (47.9) 102 (45.7)
 Female 51 (39.8) 801 (96.7) 227 (52.1) 121 (54.3)
Working duration (yr) 4.6 ± 4.7 8.2 ± 6.2 - 8.7 ± 8.1
Department
 Medical 71 (55) - - -
 Other 57 (45) 143 (17.3) - -
 Outpatient - 87 (10.5) - -
 Emergency - 77 (9.3) - -
 Inpatient - 521 (62.9) - -
 School of medicine - - 194 (44.5) -
 School of nursing - - 145 (33.3) -
 College of pharmacy - - 97 (22.3) -
 Radiology - - - 46 (20.6)
 Nursing - - - 21 (9.4)
 Administrative service - - - 156 (70)
Experience in anaphylaxis (1st or 2nd hand) 4 (3.1) 50 (6) 17 (3.9) 8 (3.6)
Experience in the treatment of anaphylaxis 70 (54.7) 161 (19.5) - -

Values are presented as mean±standard deviation or number (%).

Table 2

The percentages of correct answers to questionnaire I

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Questionnaire I Doctor (n=128) Nurse (n = 828) Student (n = 436) Health personnel (n = 223) Total (n=1,615) P-value
1. The symptom of anaphylaxis* 107 (83.6) 600 (72.5) 207 (47.5) 74 (33.2) 988 (61.2) < 0.001
2. The symptom of anaphylaxis 114 (89.1) 490 (59.2) 191 (43.8) 44 (19.7) 839 (52.0) < 0.001
3. The cause of anaphylaxis 125 (97.7) 813 (98.2) 332 (76.1) 111 (49.8) 1,381 (85.5) < 0.001
4. The cause of anaphylaxis 36 (28.1) 10 (1.2) 25 (5.7) 10 (4.5) 81 (5.0) < 0.001
5. Symptoms after re-exposure 117 (91.4) 701 (84.7) 309 (70.9) 88 (39.5) 1,215 (75.2) < 0.001
6. The administration time of epinephrine 118 (92.2) 602 (72.7) 250 (57.3) 84 (37.7) 1,054 (65.3) < 0.001
7. The site of administration of epinephrine 70 (54.7) 312 (37.7) 177 (40.6) 28 (12.6) 587 (36.4) < 0.001
8. The replacement of epinephrine 106 (82.8) 190 (22.9) 151 (34.6) 27 (12.1) 474 (29.4) < 0.001
9. The treatment of anaphylaxis 99 (77.3) 471 (56.9) 193 (44.3) 59 (26.5) 822 (50.9) < 0.001
10. The treatment of anaphylaxis 100 (78.1) 478 (57.7) 249 (57.1) 99 (44.4) 8,367 (57.3) < 0.001

Values are presented as number (%).

*The content field of question.

Table 3

The distribution of selection to questions (I4, I7, I8)

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Questionnaire I Doctor (n = 128) Nurse (n = 828) Student (n = 436) Health personnel (n = 223) P-value
I4. Which of these are not likely to cause anaphylaxis? < 0.001
 Medications 5 (3.9) 6 (0.7) 9 (2.1) 6 (2.7)
 Pollen 36 (28.1) 10 (1.2) 25 (5.9) 10 (4.5)
 Latex 15 (11.7) 40 (4.8) 21 (5.0) 10 (4.5)
 Exercise 56 (3.8) 702 (4.9) 247 (8.3) 95 (2.6)
 Stinging Insects 3 (2.3) 10 (1.2) 9 (2.1) 2 (0.9)
 Not sure 13 (10.2) 59 (7.1) 113 (26.7) 100 (44.8)
I7. Epinephrine should be injected into the < 0.001
 Arm 37 (28.9) 290 (35.0) 79 (18.1) 35 (15.7)
 Thigh 70 (54.7) 313 (37.8) 177 (40.6) 28 (12.6)
 Buttock 13 (10.2) 63 (7.6) 21 (4.8) 28 (12.6)
 Not sure 8 (6.3) 162 (19.6) 159 (36.5) 132 (59.2)
I8. Antihistamines and corticosteroids are good substitutes for epinephrine < 0.001
 Yes 13 (10.2) 447 (54.0) 119 (28.0) 47 (21.4)
 No 106 (83.5) 190 (22.9) 151 (35.5) 27 (12.3)
 Not sure 8 (6.3) 191 (23.1) 155 (36.5) 146 (66.4)

Values are presented as number (%).

Table 4

The percentages of correct answers to questionnaire II

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Questionnaire II Doctor (n = 128) Nurse (n = 828) Total (n = 956) P-value
1. The sign & symptom of anaphylaxis 125 (97.7) 737 (89.0) 862 (90.2) < 0.001
2. Diagnostic criteria 94 (73.4) 591 (71.4) 685 (71.7) < 0.001
3. The drug of choice 119 (93.0) 626 (75.6) 745 (77.9) < 0.001
4. The step of treatment 3 (2.3) 4 (0.5) 7 (0.7) 0.003
5. The interval of administration of epinephrine 73 (57.0) 324 (39.1) 397 (41.5) < 0.001
6. The route of administration of epinephrine 102 (79.7) 590 (71.3) 692 (72.4) < 0.001
7. The dose of epinephrine 76 (59.4) 320 (38.6) 396 (41.4) < 0.001
8. The location of administration of epinephrine 71 (55.5) 376 (45.4) 447 (46.8) < 0.001
9. The course of anaphylaxis 99 (77.3) 405 (48.9) 504 (52.7) < 0.001
10. The department for follow-up 122 (95.3) 795 (96.0) 917 (95.9) < 0.001

Values are presented as number (%).

Table 5

The distribution of selection to questions (II5, II7, II8)

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Questionnaire II Doctor (n = 128) Nurse (n = 828) P-value
II5. What is the interval of readministration of epinephrine? < 0.001
 No more than 1 1 (0.8) 27 (3.3)
 5 Minutes 73 (57.9) 324 (39.6)
 30 Minutes 21 (16.7) 83 (10.1)
 1 Hour 5 (4.0) 21 (2.6)
 Not sure 26 (20.6) 364 (44.4)
II7. What is the recommended dose concentration of epinephrine? < 0.001
 1:1,000 Solution 76 (60.8) 320 (39.1)
 1:100 Solution 2 (1.6) 49 (6.0)
 1:10,000 Solution 25 (20.0) 95 (11.6)
 Not sure 21 (16.8) 355 (43.3)
II8. What is the recommended administrative location of epinephrine? 0.083
 Upper arm 36 (28.8) 328 (40.7)
 Midanterior thigh 71 (56.8) 376 (46.7)
 Buttocks 18 (14.4) 101 (12.5)
Table 6

The results* according to experience of treatment

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Experience of treatment No. Mean±SD P-value
The percentages of correct answers to questionnaire I and II in doctors < 0.001
 With experience 70 78.9 ± 11.4
 Without experience 58 66.5 ± 15.0
The percentages of correct answers to questionnaire I and II in nurses < 0.001
 With experience 161 63.8 ± 14.0
 Without experience 665 55.3 ± 13.1

SD, standard deviation.

*t-test.

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