Junior doctors continue to have inadequate knowledge of anaphylaxis diagnosis and treatment

1. In the UK, an improvement was seen in the number of junior doctors able to recognize the correct adrenaline administration route from 2002 to 2013, but only 34% chose an appropriate dose and route of administration.

2. The majority of participants misidentified non-anaphylactic clinical scenarios in hypothetical cases and chose adrenaline administration when not indicated.

Evidence Rating Level: 2 (Good)

Study Rundown: Anaphylaxis is an acute hypersensitivity reaction that requires immediate medical attention. Guidelines indicate intramuscular epinephrine as treatment, but caution against epinephrine (adrenaline) use in non-anaphylactic cases. Studies show that the incidence of hospital admissions due to anaphylaxis is increasing. It is thus necessary that junior doctors have adequate knowledge about diagnosis and treatment of anaphylaxis to prevent possibly fatal consequences. The purpose of this study was to assess junior doctors’ knowledge of the management of anaphylaxis as compared to their predecessors using a survey consisting of five hypothetical patient cases. Although more junior doctors assessed in 2013 were able to recognize a true anaphylactic than their counterparts in 2002, the 2013 junior doctors chose inappropriate adrenaline administration routes more frequently than 2002 doctors. Further the majority of junior physicians surveyed in 2013 incorrectly identified foreign body inhalation as anaphylaxis and treated with adrenaline.

The findings of this study demonstrate that while junior doctors are more able to effectively recognize true anaphylaxis, the proportion able to parse differences from other clinical scenarios is quite low. A limitation of this study includes the small sample size, 107 physicians, which included participants from only one hospital. Bias and discrepancies may have been introduced due to potential increased experience of the 2002 group during survey time and undetermined proportion of 2013 participants who may have taken an ALS course. Ultimately, the study demonstrates junior doctors’ significant lack of understanding and poor ability to recognize and treat anaphylactic and non-anaphylactic scenarios that could have drastic consequences.

Click to read the study in the Postgraduate Medical Journal

Click to read an accompanying editorial in Postgraduate Medical Journal

Relevant Reading: Lessons for management of anaphylaxis from a study of fatal reaction

In-Depth [survey]: This study examined knowledge of anaphylaxis management of junior doctors in 2013as compared to their predecessors in 2002. This study enrolled 107 junior doctors who were either one (F1) or two (F2) years post-graduation at Southmead Hospital in Bristol, UK. Participants were asked to correctly diagnose and treat patients in five hypothetical cases of which only one was a real anaphylactic reaction. The scenarios included a true anaphylactic reaction, inhaled foreign body, benign urticaria, rash with antibiotics and asthma, and angioedema. It was found that for the true anaphylactic reaction although 100% of the participants chose to administer adrenaline, only 34% chose the correct dose and route. Improvement was also seen in the number of junior doctors who were able to recognize both route and administration (p=0.0029) in 2002 (13%) compared to 2013 (34%). Further, 68% of F1s chose the correct route as compared to 79% of F2s. A significant improvement was seen in the number of junior doctors that were able to identify the correct route of adrenaline (p=0.0007) in junior doctors assessed in 2002 (45%) as compared to 2013 (74%). 82% of junior doctors surveyed in 2013 misdiagnosed foreign body inhalation as anaphylaxis and treated with adrenaline.

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