A survey of emergency department management of acute urticaria in children.
OBJECTIVE
To describe emergency department management of acute urticaria in children and to determine factors associated with management strategies and adherence to practice guidelines.


METHODS
Self-administered cross-sectional survey mailed to all Section of Emergency Medicine members of the American Academy of Pediatrics (n = 1190) and 1000 randomly selected members of the American College of Emergency Physicians. Main outcome measure was proportion of respondents adhering to published guidelines. Factors associated with management strategies were analyzed using bivariate and logistic regression analyses.


RESULTS
Of 2190 surveys sent, 1137 (52.5%) were available for analysis. Respondents included 44.6% pediatric emergency physicians, 36.4% emergency physicians, and 15.3% pediatricians. First-generation histamine (H)1 antagonists alone were the most common therapy used on initial presentation of acute urticaria, followed by corticosteroids, H2 antagonists, and second-generation H1 antagonists, used by only 7.8%, despite their recommendation as first-line therapy. Physicians working in an emergency department as opposed to an urgent or primary care setting were less likely to use second-generation H1 antagonists (odds ratio [OR], 0.3 [0.1-0.7]). General emergency physicians were 2.6 times more likely to use H2 antagonists and more than 3 times as likely to use corticosteroids. Only 14.2% of physicians overall were familiar with guideline recommendations.


CONCLUSIONS
Minimal awareness and use of existing guidelines, and low concordance with published recommendations exist. Management practices vary and are influenced by training, practice setting, and clinical experience.
Beno
Suzanne M
SM
Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. suzannebeno@hotmail.com
Nadel
Frances M
FM
Alessandrini
Evaline A
EA
D000208:Acute Disease; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006634:Histamine H1 Antagonists / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014581:Urticaria / Q000188:drug therapy*
D006634:Histamine H1 Antagonists