Severe anaphylactic reaction to contrast agent: teams are well prepared but should simulate the situations regularly

TL;DR

Doctors can diagnose severe anaphylaxis but struggle with proper treatment and using adrenaline autoinjectors, suggesting a need for more training.

Contribution

The study reveals gaps in physicians' ability to manage anaphylaxis despite correct diagnosis, emphasizing the need for regular simulation training.

Findings

All 95 doctors correctly diagnosed anaphylaxis, but 66% were uncertain about first-line therapy.

68% of doctors had difficulty using the adrenaline autoinjector correctly.

Abstract

Anaphylactic reactions are dramatic and life-threatening. According to international guidelines, the immediate intramuscular administration of adrenaline is the most important first step for acute management. The aim of this study is to determine whether doctors can recognize and treat severe anaphylactic reactions to contrast agents adequately.

In this study, 95 doctors were interviewed between January and June 2023 in European clinics that are not affiliated with the authors. Ninety-five doctors from radiology, internal medicine, and anaesthesia departments were randomly selected for interviews. A video was prepared simulating a male patient developing a severe anaphylactic reaction during CT after intravenous administration of an iodinated contrast medium. After the video, 95 doctors were interviewed (59 radiologists, 19 internists, and 17 anaesthesiologists). The doctors were asked 3 questions: (1) What is the diagnosis? (2) What is the therapy of choice? (3) Can you demonstrate the correct way to operate the adrenaline autoinjector?

All 95 doctors made the correct diagnosis (100%). Sixty-three of 95 physicians (66%) were uncertain regarding the appropriate first-line therapy. This was observed across all three medical specialties (internal medicine, anaesthesiology, and radiology) (P = .64). Sixty-five physicians (68%) had difficulties triggering the autoinjection system successfully.

Acute anaphylaxis is life-threatening, but there is uncertainty among professional groups about initiating acute management. Refresher training should be considered to ensure timely and appropriate treatment of the condition when it occurs.

This study highlighted significant gaps in physicians’ real-world readiness to manage acute anaphylaxis, despite all doctors correctly diagnosing the condition.

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