P030 - Prévalence de l'utilisation de l'adrénaline dans la prise en charge pré-hospitalière et hospitalière des réactions anaphylactiques de l'enfant

Jean-Louis Montserret (1), Camille Bréhin (2), Audrey Martin-Blondel (3), Isabelle Claudet (2)

1. Urgences, Centre hospitalier de Castres, Castres, France
2. Urgences pédiatriques, Hôpital des Enfants-CHU Toulouse, Toulouse, France
3. Pneumo-Allergologie pédiatrique, CHU Toulouse, Toulouse, France

Diffusion le 10/05/2016

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Introduction : L'adrénaline est le traitement de première intention de l'anaphylaxie sévère de l'enfant selon les recommandations 2006 de la World Allergy Organization.

Objectif - Evaluer la prévalence de son utilisation dans l'anaphylaxie sévère de l'enfant au niveau des hôpitaux d'une même région.

Patients et Méthodes : Sur la période 2012-2013, les dossiers d'enfants âgés de moins de 15 ans dont le code diagnostic était codé J46, J384, J393, L500, L509, T780, T782, T784 ont été rétrospectivement sélectionnés, et les patients ayant un critère clinique de gravité justifiant l'administration d'adrénaline ont été inclus.

Résultats : Sur la période, 116 patients ont été inclus (58 issus du CHU, 58 des CHR) et auraient dû bénéficier d'une injection d'adrénaline. Elle a été injectée chez 49 patients (42,2%), 42 patients en CHU et 7 autres en CHR. La posologie et la voie d'administration étaient adaptées dans 100% des cas. La moyenne d'âge des patients était de 5,8± 4,3 ans, il existait un gradient de gravité clinique inversement lié à l'âge : le groupe d'âge inférieur à 2 ans comportait 42% de patients graves (3,2 [1,3-7,9[, p=0,014). Le transport était médicalisé dans 8% des cas, 45% d'entre eux étaient exempts d'antécédents allergiques. Les manifestations cliniques étaient essentiellement cutanéomuqueuses (62%) et respiratoires (28%). Une expansion volémique par cristalloïdes était prescrite chez 20 patients (91% des patients hypotendus). Il n'existait pas de différence en terme de gravité entre les patients ayant reçu de l'adrénaline et les autres. Parmi les patients présentant des critères de gravité clinico-biologiques (n=27), 40% ont bénéficié d'une injection d'adrénaline. Un antihistaminique H1 ou un corticoïde seul était prescrit dans 15% des cas, la posologie de la méquitazine, antiH1 le plus prescrit, était sous dosée chez 42% des enfants. A l'issue de la surveillance aux urgences, une hospitalisation était nécessaire dans 59,5% des cas.

Conclusion : Dans des situations où elle est recommandée, l'utilisation de l'adrénaline reste insuffisante. Des réticences à son injection persistent notamment en lien avec l'hypothétique risque cardiovasculaire secondaire, risque théorique dans la population pédiatrique exempte de pathologies coronariennes.

Tags : anaphylaxie adrénaline pédiatrie

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med_description_longue => '<p>Introduction&nbsp;: L'adr&eacute;naline est le traitement de premi&egrave;re intention de l'anaphylaxie s&eacute;v&egrave;re de l'enfant selon les recommandations 2006 de la World Allergy Organization.<br /> <br /> Objectif - Evaluer la pr&eacute;valence de son utilisation dans l'anaphylaxie s&eacute;v&egrave;re de l'enfant au niveau des h&ocirc;pitaux d'une m&ecirc;me r&eacute;gion.<br /> <br /> Patients et M&eacute;thodes&nbsp;: Sur la p&eacute;riode 2012-2013, les dossiers d'enfants &acirc;g&eacute;s de moins de 15 ans dont le code diagnostic &eacute;tait cod&eacute; J46, J384, J393, L500, L509, T780, T782, T784 ont &eacute;t&eacute; r&eacute;trospectivement s&eacute;lectionn&eacute;s, et les patients ayant un crit&egrave;re clinique de gravit&eacute; justifiant l'administration d'adr&eacute;naline ont &eacute;t&eacute; inclus.<br /> <br /> R&eacute;sultats&nbsp;: Sur la p&eacute;riode, 116 patients ont &eacute;t&eacute; inclus (58 issus du CHU, 58 des CHR) et auraient d&ucirc; b&eacute;n&eacute;ficier d'une injection d'adr&eacute;naline. Elle a &eacute;t&eacute; inject&eacute;e chez 49 patients (42,2%), 42 patients en CHU et 7 autres en CHR. La posologie et la voie d'administration &eacute;taient adapt&eacute;es dans 100% des cas. La moyenne d'&acirc;ge des patients &eacute;tait de 5,8&plusmn; 4,3 ans, il existait un gradient de gravit&eacute; clinique inversement li&eacute; &agrave; l'&acirc;ge&nbsp;: le groupe d'&acirc;ge inf&eacute;rieur &agrave; 2 ans comportait 42% de patients graves (3,2 [1,3-7,9[, p=0,014). Le transport &eacute;tait m&eacute;dicalis&eacute; dans 8% des cas, 45% d'entre eux &eacute;taient exempts d'ant&eacute;c&eacute;dents allergiques. Les manifestations cliniques &eacute;taient essentiellement cutan&eacute;omuqueuses (62%) et respiratoires (28%). Une expansion vol&eacute;mique par cristallo&iuml;des &eacute;tait prescrite chez 20 patients (91% des patients hypotendus). Il n'existait pas de diff&eacute;rence en terme de gravit&eacute; entre les patients ayant re&ccedil;u de l'adr&eacute;naline et les autres. Parmi les patients pr&eacute;sentant des crit&egrave;res de gravit&eacute; clinico-biologiques (n=27), 40% ont b&eacute;n&eacute;fici&eacute; d'une injection d'adr&eacute;naline. Un antihistaminique H1 ou un cortico&iuml;de seul &eacute;tait prescrit dans 15% des cas, la posologie de la m&eacute;quitazine, antiH1 le plus prescrit, &eacute;tait sous dos&eacute;e chez 42% des enfants. A l'issue de la surveillance aux urgences, une hospitalisation &eacute;tait n&eacute;cessaire dans 59,5% des cas.<br /> <br /> Conclusion&nbsp;: Dans des situations o&ugrave; elle est recommand&eacute;e, l'utilisation de l'adr&eacute;naline reste insuffisante. Des r&eacute;ticences &agrave; son injection persistent notamment en lien avec l'hypoth&eacute;tique risque cardiovasculaire secondaire, risque th&eacute;orique dans la population p&eacute;diatrique exempte de pathologies coronariennes.</p>'
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/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Route.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Route/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Route/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Route/Module.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Route/Static.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Date.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Date/DateObject.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Adapter/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Adapter/Pdo/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Adapter/Pdo/Mysql.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Expr.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Profiler.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Select.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement/Pdo.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table/Definition.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Inflector.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/PregReplace.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/StringToLower.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/CamelCaseToDash.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/CamelCaseToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/Separator/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/SeparatorToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/UnderscoreToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout/Controller/Action/Helper/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout/Controller/Plugin/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/Autoloader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/PluginLoader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/PluginLoader/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Data.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Format.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Math.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/FactoryInterface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Priority.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Writer/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Registry.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Namespace.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/SaveHandler/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Uri.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Version.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Doctype.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadMeta.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadTitle.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Standalone.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Registry.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Url.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Interface.php

ZFDebug Files

/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Cache.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Database.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/File.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log/Writer.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Text.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Variables.php