Timothy Dribin, MD, Lead Author on Study That Identifies Safe Discharge Window for Kids Seeking Treatment for Anaphylaxis

CCTST K Scholar graduate, Timothy Dribin, MD, recently published a study in The Lancet: Child and Adolescent Health titled, “Timing of repeat epinephrine to inform paediatric anaphylaxis observation periods: a retrospective cohort study”.

Dr. Dribin, the lead author of the study, examined how children visiting emergency departments for allergic reactions can often be treated and safely discharged quickly – particularly those with epinephrine injectors. However, around 5% may experience a delayed “biphasic reaction,” leading to extended observation out of caution. The study aimed to identify low-risk patients who could be safely sent home sooner.

Researchers analyzed 5,641 emergency cases of anaphylaxis treated with epinephrine. Most reactions were food-related, with some due to medications or insect stings. Though 17% of children were admitted for overnight observation, with others staying in the emergency department for 4 or more hours, the need for a second epinephrine dose usually occurred within two hours – only 1.9% required it after four hours. Just 1% needed intensive interventions like ventilators.

The study found that children without cardiovascular symptoms were at very low risk of needing further treatment after two hours, and even those with such symptoms were unlikely to need more after four hours.

The authors highlighted several benefits for improving emergency department efficiency in managing anaphylaxis cases. These include increased clinician confidence in deciding whether to discharge or keep patients, reduced patient hesitation to seek care due to shorter stays, which help free up beds – particularly valuable during the busy winter infection season. While the study did not estimate cost savings due to variability in hospital pricing and practices, the authors noted that avoiding unnecessary admissions could result in substantial financial savings.

More information about the study can be found on the Cincinnati Children’s Research Horizons blog.