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Most patients unable to use adrenaline auto-injectors properly after training

Less than half of the mothers in a randomized controlled trial properly administered an adrenaline auto-injector to their children during a simulated anaphylaxis scenario 6 weeks after receiving training, according to study results.

“Using a more rigorous simulated anaphylaxis scenario and prospective study design, we have clearly shown that device design is a critical factor in successful [adrenaline auto-injector (AAI)] use and that success rates using commonly prescribed devices are worryingly low even 6 weeks following training,” Sunthar Umasunthar, MD, of Imperial College London, and colleagues wrote.

The researchers randomly assigned 158 mothers of children aged 0 to 18 years with food allergy to either Anapen (epinephrine, Lincoln Medical; n = 79) or EpiPen (epinephrine, Mylan; n = 79) to investigate the effect of AAI device design on a participant’s ability to properly administer the device to a child in a simulated event 6 weeks and 1 year after training.

Participants were recruited from a pediatric allergy center in London between March 2011 and December 2012. Participants were excluded for several reasons, including previous training using an AAI device.

Successful device application barely differed between Anapen (42.3%) and EpiPen (42.5%) 6 weeks after training (RR = 1; 95% CI, 0.68-1.46).

There was very minimal change in the ability to properly administer adrenaline 1 year after participants were trained (n = 108) and given new devices. Successful AAI administration using the 5-second criterion was 63% using the old device and 60.2% using a new device.

Participants (n = 28) randomly assigned to use audio prompts from Auvi-Q (Sanofi), however, saw the highest success rate of all participants using new devices (93%).

“In contrast to previous work, our data clearly demonstrate that AAI device design, not simply AAI training, is critical for successful adrenaline delivery in an emergency scenario,” the researchers wrote.

Disclosure: Umasunthar reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.