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Open Access Publications from the University of California

Autoinjectors Preferred for Intramuscular Epinephrine in Anaphylaxis and Allergic Reactions


Introduction: Epinephrine is the treatment of choice for anaphylaxis. We surveyed emergency department (ED) health care providers regarding 2 methods of intramuscular (IM) epinephrine administration (autoinjector and manual injection) for the management of anaphylaxis and allergic reactions and identified provider perceptions and preferred method of medication delivery.

Methods: This observational study adhered to survey reporting guidelines. It was performed through a Web-based survey completed by health care providers at an academic ED. The participants consisted of all ED providers, including staff physicians, resident physicians, pharmacists, advanced practice providers, and nurses. The primary outcomes were assessment of provider perceptions and identification of the preferred IM epinephrine administration method by ED health care providers.

Results: Of 217 ED health care providers invited to participate, 172 (79%) completed the survey. Overall, 82% of respondents preferred the autoinjector method of epinephrine administration. Providers rated the autoinjector method more favorably with regard to time required for training, ease of use, convenience, satisfaction with weight-based dosing, risk of dosing errors, and speed of administration (P<.001 for all comparisons). However, manual injection use was rated more favorably with regard to risk of provider self-injury and patient cost (P<.001 for both comparisons). Three participants (2%) reported a finger stick injury from an epinephrine autoinjector.

Conclusion: ED health care providers preferred the autoinjector method of IM epinephrine administration for the management of anaphylaxis or allergic reactions. Epinephrine autoinjector use may reduce barriers to epinephrine administration for the management of anaphylaxis in the ED.

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