ReviewHazards of unintentional injection of epinephrine from autoinjectors: a systematic review
Section snippets
INTRODUCTION
Anaphylaxis occurs frequently in the community, in settings where health care professionals are not present. First aid treatment focuses on prompt injection of epinephrine from an autoinjector, such as EpiPen (0.3 mg) or EpiPen Jr (0.15 mg) (Dey LP, Napa, California) or Twinject 0.3 mg or Twinject 0.15 mg (Shionogi & Co Ltd, Osaka, Japan).1, 2, 3, 4, 5, 6
The true rate of occurrence of unintentional epinephrine injections from autoinjectors is currently unknown. In the past, however, they have
METHODS
A systematic review was performed to identify reports of unintentional epinephrine injections from autoinjectors published in the English language in peer-reviewed journals. The MEDLINE (January 1966 to April 30, 2008), Scirus, CINAHL (1982 to April 30, 2008), ISI Web of Science (1965 to April 30, 2008), and Google Scholar (1950 to April 30, 2008) databases were searched by title and abstract. Keywords searched included accident epinephrine, accidental epinephrine, accident adrenaline,
RESULTS
The results of the systematic review are summarized in Table 1. After the additional exclusion criteria outlined in Figure 1 were applied, 26 reports published between 1989 and April 30, 2008, were identified for review. Eleven of these were published in the emergency medicine literature, 7 in the general medical literature, 6 in the surgical literature, and 2 in the allergy literature (Table 2).7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32
DISCUSSION
We identified 69 cases of unintentional injection of epinephrine from autoinjectors that have been published in peer-reviewed journals during the past 20 years,7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32 most of them in the past 6.3 years.24 The rate of occurrence of unintentional injections, which was previously projected to be 1 in 50,000 injections,10 has almost certainly been underestimated. After this systematic review was completed,
ACKNOWLEDGMENTS
We thank Rita Mrvos, BSN, et al, for providing previously unpublished data from reference 24 and Erica L. Liebelt, MD, for helpful discussions regarding reference 34. We also thank Lori McNiven for her assistance.
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Disclosures: Dr Simons has served on the Dey Advisory Board, Intelliject Advisory Board, and Alk-Abello Advisory Board. Dr Lieberman has served as a consultant and/or speaker for Dey, Intelliject, Meda, Alcon, Schering, Glaxo, UCB, Pfizer, Genentech, Novartis, and Teva and has served on the Dey and Intelliject Advisory Boards. Dr Read is a scientific advisor, investor, and member of Intelliject. Mr Edwards is an employee and shareholder (> $10,000) of Intelliject.