title: Treatment of a simulated child with anaphylaxis: an in situ two-arm study.
abstract: OBJECTIVE
  This study aims to determine whether junior medical staff correctly identify and treat paediatric anaphylaxis and whether the presence or absence of hypotension influenced the treatment, using a standardised simulated patient encounter.
  
  
  METHODS
  Junior medical staff from the emergency department of a large paediatric tertiary hospital were invited to participate in a two-armed cohort study to assess recognition and management of anaphylaxis in a standardised scenario using a simulated patient with and without hypotension. The primary outcome measure was administration of adrenaline. The secondary outcome measures included time to adrenaline administration, ability to seek and identify relevant features of history and clinical examination and use of other medications.
  
  
  RESULTS
  Fifty-six junior medical staff participated (90% participation rate). Only 50% of participants administered adrenaline in scenarios of definite anaphylaxis. Adrenaline was more likely to be administered if the scenario included hypotension, where the junior medical officer had previous formal resuscitation training (Advanced Paediatric Life Support) and by medical officers with more years of training.
  
  
  CONCLUSIONS
  Anaphylaxis is a life-threatening presentation and requires prompt recognition and appropriate adrenaline administration. Junior medical staff may require more emphasis on recognition and prompt adrenaline administration in both undergraduate and in hospital training and education. Simulated scenarios may provide a platform to deliver this training to ultimately improve patient care.
authors.affiliation: Emergency Department, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia. fenton.oleary@health.nsw.gov.au
authors.forename: Fenton M
authors.initials: FM
authors.lastname: O'Leary
authors.forename: Belinda
authors.initials: B
authors.lastname: Hokin
authors.forename: Kevin
authors.initials: K
authors.lastname: Enright
authors.forename: Dianne E
authors.initials: DE
authors.lastname: Campbell
mesh_terms: D000707:Anaphylaxis / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000627:therapeutic use*; D006776:Hospitals, Pediatric; D006801:Humans; D008505:Medical Staff, Hospital; D013566:Sympathomimetics / Q000627:therapeutic use*
chemical_list: D013566:Sympathomimetics; D004837:Epinephrine
keywords: anaphylaxis; paediatrics; patient simulation