Significance of an accurate triage in anaphylaxis identification and management: Concerning a few cases.

Abstract

Anaphylaxis requires immediate medical assistance. Triage systems are Emergency Departments´ entrance and prioritize medical attention. Anaphylaxis´ peculiarities can hinder its identification and attention.

Our aim was to show this point by the analysis of a sample of cases prioritized at our Hospital´s Paediatric Emergency Department (PED) by means of its version of the Canadian Paediatric Triage and Acuity Scale (PaedCTAS). It includes initial assessment by Pediatric Assessment Triangle, main complaint evaluation and discriminators´ record, obtaining a priorization level, expected time for physician evaluation and location at PED. Cases included: (a) Nine-year-old child who referred a food-induced anaphylaxis treated with his self-injectable epinephrine device; (b) Three-year old child referred from his Health Center after epinephrine administration; (c) Eleven-year-old child with previous food Allergy who referred food-induced urticaria; (d) Eleven-year-old child with anaphylactic shock. The first case received an intermediate priority level and was located in waiting room. Case b was identified correctly and referred to Resuscitation Room. Case (c) collapsed in the waiting room after medical evaluation and (d) was correctly prioritized, attended at Resuscitation and admitted at Paediatric Intensive Care.

Relying only on initial assessment can lead to errors in anaphylaxis´ identification. Useful data for accurate allergy triage should include: careful assessment of non-skin symptoms since anaphylaxis is a systemic disease; previous allergy diseases should be taken into account to identify patients at-risk of anaphylaxis; symptom duration should be considered in the assessment, since it may rule out the diagnosis.

Delays in medical assessment and epinephrine administration can endanger anaphylaxis´ prognosis.