title: Anaphylaxis knowledge and practice preferences of pediatric emergency medicine physicians: a national survey.
abstract: OBJECTIVE
  To assess the knowledge and practice preferences of anaphylaxis in pediatric emergency medicine (PEM) physicians by practice setting, and to identify factors associated with intramuscular (IM) epinephrine administration and admission of patients with anaphylaxis.
  
  
  METHODS
  The cohort was a cross-sectional convenience sample; potential participants were recruited using contact information obtained from the American Board of Pediatrics and American Board of Medical Specialties membership databases and were asked to complete a 12 item survey. Board-certified PEM physicians were categorized by practice setting: university hospital, non-university hospital with a residency training program, or community hospital with no residency training program. Management practices based on practice setting are presented as proportions. Multivariate logistic regression identified factors associated with IM epinephrine administration and admission of patients with anaphylaxis for observation.
  
  
  RESULTS
  Of the 1114 PEM physicians solicited, 620 (56%) completed the survey. The majority (93.5%) correctly identified epinephrine as the treatment of choice for anaphylaxis, yet only 66.9% used the IM route of administration, and only 37.4% admitted affected patients for observation. Factors associated with the use of IM epinephrine included the presence of a residency program at the site of care (OR, 2.28, 95% CI, 1.3-4.04) and higher volume of anaphylaxis cases (OR, 1.21; 95% CI, 1.06-1.38). Increasing anaphylaxis case volume was associated with decreased likelihood of admission of patients with anaphylaxis (OR, 0.81; 95% CI, 0.72-0.92).
  
  
  CONCLUSIONS
  Even though the majority of PEM physicians correctly report using epinephrine in pediatric anaphylaxis, not all use the preferred administration route, and many discharge patients home after an abbreviated period.
authors.affiliation: Department of Emergency Medicine, Miami Children's Hospital, Miami, FL, USA.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Grossman
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Baumann
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Garcia Peña
authors.forename: Marc Y-R
authors.initials: MY
authors.lastname: Linares
authors.forename: Barry
authors.initials: B
authors.lastname: Greenberg
authors.forename: Vivian P
authors.initials: VP
authors.lastname: Hernandez-Trujillo
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004635:Emergency Medicine; D004837:Epinephrine / Q000627:therapeutic use*; D019538:Health Care Surveys; D006801:Humans; D007273:Injections, Intramuscular; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D057566:Self Report; D013566:Sympathomimetics / Q000627:therapeutic use*; D014481:United States
chemical_list: D013566:Sympathomimetics; D004837:Epinephrine
keywords: ED; Emergency department; IM; Intramuscular; PEM; Pediatric emergency medicine