title: Unintentional Epinephrine Auto-injector Injuries: A National Poison Center Observational Study.
abstract: BACKGROUND
  Epinephrine is the only first-line therapeutic agent used to treat life-threatening anaphylaxis. Epinephrine auto-injectors are commonly carried by patients at risk for anaphylaxis, and reported cases of unintentional auto-injector injury have increased over the last decade. Modifications of existing designs and release of a new style of auto-injector are intended to reduce epinephrine auto-injector misuse.
  
  
  OBJECTIVE
  The aim of the study was to characterize reported cases of unintentional epinephrine auto-injector exposures from 2013 to 2014 and compare demographics, auto-injector model, and anatomical site of such exposures.
  
  
  METHODS
  The American Association of Poison Control Center's National Poison Data System was searched from January 1, 2013, to December 31, 2014, for cases of unintentional epinephrine auto-injector exposures. Anatomical site data were obtained from all cases reported to the Virginia Poison Center and participating regional poison center for Auvi-Q cases.
  
  
  RESULTS
  A total of 6806 cases of unintentional epinephrine auto-injector exposures were reported to US Poison Centers in 2013 and 2014. Of these cases, 3933 occurred with EpiPen, 2829 with EpiPen Jr, 44 with Auvi-Q, and no case reported of Adrenaclick. The most common site of unintentional injection for traditional epinephrine auto-injectors was the digit or thumb, with 58% of cases for EpiPen and 39% of cases with EpiPen Jr. With Auvi-Q, the most common site was the leg (78% of cases).
  
  
  CONCLUSIONS
  The number of unintentional epinephrine auto-injector cases reported to American Poison Centers in 2013-2014 has increased compared with previous data. Most EpiPen exposures were in the digits, whereas Auvi-Q was most frequently in the leg. Because of the limitations of Poison Center data, more research is needed to identify incidence of unintentional exposures and the effectiveness of epinephrine auto-injector redesign.
authors.affiliation: School of Medicine, Virginia Commonwealth University, Richmond, VA.
authors.forename: Marco
authors.initials: M
authors.lastname: Anshien
authors.affiliation: Virginia Poison Center, Virginia Commonwealth University, Richmond, VA.|Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA.
authors.forename: S Rutherfoord
authors.initials: SR
authors.lastname: Rose
authors.affiliation: Virginia Poison Center, Virginia Commonwealth University, Richmond, VA.|Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA.
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Wills
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D004867:Equipment Design; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D000075662:Injection Site Reaction / Q000453:epidemiology* / Q000209:etiology; D007279:Injections, Subcutaneous / Q000009:adverse effects / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011039:Poison Control Centers / Q000706:statistics & numerical data*; D012646:Self Administration / Q000009:adverse effects / Q000295:instrumentation; D055815:Young Adult
chemical_list: D004837:Epinephrine