title: Lacerations and Embedded Needles Caused by Epinephrine Autoinjector Use in Children.
abstract: OBJECTIVE
  Epinephrine autoinjector use for anaphylaxis is increasing. There are reports of digit injections because of incorrect autoinjector use, but no previous reports of lacerations, to our knowledge. We report complications of epinephrine autoinjector use in children and discuss features of these devices, and their instructions for use, and how these may contribute to injuries.
  
  
  METHODS
  We queried emergency medicine e-mail discussion lists and social media allergy groups to identify epinephrine autoinjector injuries involving children.
  
  
  RESULTS
  Twenty-two cases of epinephrine autoinjector-related injuries are described. Twenty-one occurred during intentional use for the child's allergic reaction. Seventeen children experienced lacerations. In 4 cases, the needle stuck in the child's limb. In 1 case, the device lacerated a nurse's finger. The device associated with the injury was operated by health care providers (6 cases), the patient's parent (12 cases, including 2 nurses), educators (3 cases), and the patient (1 case). Of the 3 epinephrine autoinjectors currently available in North America, none include instructions to immobilize the child's leg. Only 1 has a needle that self-retracts; the others have needles that remain in the thigh during the 10 seconds that the user is instructed to hold the device against the leg. Instructions do not caution against reinjection if the needle is dislodged during these 10 seconds.
  
  
  CONCLUSIONS
  Epinephrine autoinjectors are lifesaving devices in the management of anaphylaxis. However, some have caused lacerations and other injuries in children. Minimizing needle injection time, improving device design, and providing instructions to immobilize the leg before use may decrease the risk of these injuries.
authors.affiliation: Seattle Children's Hospital and University of Washington, Seattle, WA. Electronic address: julie.brown@seattlechildrens.org.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Brown
authors.affiliation: Medical University South Carolina Children's Hospital, Charleston, SC.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Tuuri
authors.affiliation: Seattle Children's Hospital and University of Washington, Seattle, WA.
authors.forename: Sabreen
authors.initials: S
authors.lastname: Akhter
authors.affiliation: Lawrence General Hospital, Lawrence, MA.
authors.forename: Lilia D
authors.initials: LD
authors.lastname: Guerra
authors.affiliation: Baystate Medical Center, Springfield, MA.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Goodman
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Sage R
authors.initials: SR
authors.lastname: Myers
authors.affiliation: Rosalind Franklin University, Chicago, IL.
authors.forename: Charles
authors.initials: C
authors.lastname: Nozicka
authors.affiliation: Boston Children's Hospital, Boston, MA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Manzi
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Katharine
authors.initials: K
authors.lastname: Long
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Troy
authors.initials: T
authors.lastname: Turner
authors.affiliation: Children's Mercy Hospitals & Clinics, University of Missouri Kansas City School of Medicine, Kansas City, MO.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Conners
authors.affiliation: Boston Medical Center and Boston University, Boston, MA.
authors.forename: Rachel W
authors.initials: RW
authors.lastname: Thompson
authors.affiliation: Seattle Children's Hospital and University of Washington, Seattle, WA.
authors.forename: Esther
authors.initials: E
authors.lastname: Park
mesh_terms: D000707:Anaphylaxis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage*; D004867:Equipment Design / Q000009:adverse effects; D004869:Equipment Safety; D005260:Female; D005383:Finger Injuries / Q000453:epidemiology / Q000209:etiology*; D005547:Foreign Bodies / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007049:Iatrogenic Disease; D007273:Injections, Intramuscular / Q000009:adverse effects; D022125:Lacerations / Q000453:epidemiology / Q000209:etiology*; D007869:Leg Injuries / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D016602:Needlestick Injuries / Q000453:epidemiology / Q000209:etiology*; D012646:Self Administration / Q000009:adverse effects; D061108:Social Media
chemical_list: D004837:Epinephrine