Ambulance transport times for children and adult patients with anaphylaxis: A retrospective analysis

Ambulance transport times for children and adult patients with anaphylaxis: A retrospective analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ambulance transport times for children and adult patients with anaphylaxis: A retrospective analysis Aina Takeuchi, Shinya Takeuchi, Marina Minami, Taku Oishi, Kingo Nishiyama, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5647576/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Anaphylaxis is a fatal condition that can cause respiratory or cardiac arrest within 30 min. Therefore, it is important to shorten the time from the emergency call to hospital arrival as much as possible. However, children with anaphylaxis in rural areas may require more time for ambulance transport than do adults because of the lack of nearby pediatric medical facilities. Thus, we aimed to compare ambulance transport times between children and adults with anaphylaxis. Methods This retrospective observational study used data from the Kochi-Iryo-Net database. We included patients with anaphylaxis who were transported to the emergency department between April 1, 2015 and March 31, 2021. Children were defined as those aged < 15 years. The primary outcome measure was the total time required for ambulance transportation. To adjust for patient background, we performed multiple linear regression analyses of the outcomes. Results During the study period, 797 patients with anaphylaxis were transported to the emergency department, among whom 155 (19.4%) were children. There was no significant difference in the total ambulance transport time (children: 31 min vs. adults: 32 min, p = 0.41). However, the time from site departure to hospital arrival was 5 min longer for children (16 min vs. adults: 11 min, p < 0.01). Conclusions While no significant difference was observed in the total transport time between children and adult patients with anaphylaxis, there may be potential to optimize the time from site departure to hospital arrival for pediatric cases. Trial registration: not applicable. Anaphylaxis Children Japan Ambulances Transportation of Patients Figures Figure 1 Figure 2 BACKGROUND Anaphylaxis is a fatal condition that can result in respiratory or cardiac arrest.[ 1 – 3 ] The lifetime prevalence of anaphylaxis is estimated to be 0.3–5.1%.[ 4 , 5 ] In children, the incidence of anaphylaxis is reported to be 1–761 per 100,000 person-years.[ 6 ] In the early stages of anaphylaxis, it is difficult to predict the speed of progression and eventual severity, and death may occur within minutes.[ 7 ] Therefore, it is important to shorten the time from the emergency call to hospital arrival as much as possible. The treatment for anaphylaxis is early intramuscular injection of adrenaline. In Japan, the rate of adrenaline autoinjectors (AAIs) or administered by others increased from 7% in 2013 to 27% in 2018,[ 8 ] although most patients were not administered adrenaline before hospital admission. Furthermore, it may be difficult to accept a case of a child with anaphylaxis as an emergency in a general hospital because the dose of adrenaline varies depending on body weight. Therefore, emergency transportation acceptance of these cases may take longer than that for adults. Particularly in rural areas, access to a central location may take longer, further delaying responses. To the best of our knowledge, no studies have compared the time required to transport children with anaphylaxis to the emergency department with that of adults. Furthermore, no studies have compared the temporal segments within the transport process for anaphylaxis cases, such as the time from emergency call to arrival at the site, the duration of stay at the site, and the period from departure from the site to hospital arrival. Therefore, in this study, we compared the time required for emergency transportation between children and adults with anaphylaxis. METHODS Study design This retrospective observational study used data from the Kochi-Iryo-Net, Kochi Prefecture’s emergency medical and wide-area disaster information systems. The Kochi Prefecture is a rural area in Japan with a total population of 655,698 (2024 census) and an area of 7,104 square kilometers.[9] It accounts for 1.9% of Japan’s total land area and has an elongated fan-shaped topography facing the Pacific Ocean in the southern half of Shikoku, with a coastline extending 713 km from East to West. To the North, the Shikoku Mountains are made up of steep mountain ranges over 1,000 m high, and forested areas account for 84% of the prefecture’s total land area. In the center, 47.8% of the population lives in Kochi City, with 10.7% aged <15 years. 9 When the ambulance team transports patients to the emergency department, the team enters the information into the Kochi-Iryo-Net database. The ambulance teams use dedicated tablets to accurately record various time points, including the total transport time, the time from the emergency call to arrival at the site, time spent at the site, and time from site departure to hospital arrival. The medical institution’s destination, severity, and up to three diagnoses are recorded by the physician who treats the patient. All data are compiled by the Kochi Prefecture. We extracted data on emergency transport from the Kochi-Iryo-Net database. The study period was from April 1, 2015 to March 31, 2021. Patients diagnosed with anaphylaxis were included in the study. We defined children as those aged <15 years. The ages were categorized into 5-year increments as per the data provided by the Kochi Prefecture. Patients with missing data were excluded. Data collection and measurements The primary outcome measure was the total time required for ambulance transportation, defined as the time from the emergency call to hospital arrival. The secondary outcomes were the duration of the time from the emergency call to arrival at the site, stay at the site, and time from site departure to hospital arrival. We investigated patient characteristics such as sex, illness severity, and location of ambulance departments. Illness severity was classified as either hospitalization or non-hospitalization. The locations of the ambulance departments were categorized as Kochi City (the most urban area) or others. Statistical analysis The median and interquartile range were calculated for each time point, and the number of cases and percentages were calculated for the nominal variables. As the data were non-normally distributed, Mann–Whitney U tests were used to compare each time point. The Fisher’s exact test was used to compare group differences in sex distribution, ambulance department, and severity of illness. Multiple linear regression analysis for the primary outcome and outcomes with statistically and clinically significant differences was performed to identify factors influencing patient characteristics. Clinically significant differences in terms of time were defined as at least 5 min based on a previous study.[7] The independent variables were children (adults as the reference), location of ambulance department (others as the reference), sex (female as the reference), and illness severity (non-hospitalization as the reference). Independent variables were selected based on a priori hypotheses. Statistical significance was set at a two-tailed p-value of <0.05. All data analyses were performed using EZR software, V.1.33 (Saitama Medical Center, Jichi Medical University, Saitama, Japan), which is a graphical user interface for R (The R Foundation for Statistical Computing, Vienna, Austria). Specifically, it is a modified version of the R commander designed to add statistical functions frequently used in biostatistics.[10] RESULTS During the 6-year study period, 242,332 ambulance transportations and 805 anaphylactic cases were recorded. We excluded eight cases with missing data; thus, data of 797 cases were extracted for analysis (Figure 1). The ambulance transport characteristics during this period are listed in Table 1. During the study period, 155 children (19.4%) were transported because of anaphylaxis. There were no deaths owing to anaphylaxis. The severity of illness and sex were not significantly different between the children and adults. However, the prevalence of transport from Kochi City was significantly higher for children than for adults (47.1% vs. 37.2%; p=0.03). The most prevalent age group in this study was 65–69 years followed by 0–4 years (Figure 2). Table 1 . Characteristics of ambulance transport for anaphylaxis during the study period Pediatric patients (Age <15 years) Adult patients (Age ≥15 years) p-value Total 155 642 Sex, n (%) Male 97 (62.6) 378 (58.9) 0.41 Disposition, n (%) hospitalization 94 (60.6) 176 (63.77) 1.00 Department, n (%) Kochi City 73 (47.1) 239 (37.2) 0.03 Transport time, min (IQR) Total transport time 31 (25–39.5) 32 (25–43) 0.41 Time from emergency call to arrival at the site 7 (5–9.5) 8 (6–11) <0.01 Time to stay at the site 7 (5–10) 10 (7–14) <0.01 Time from the site departure to the hospital arrival 16 (11–22) 11 (6–19) <0.01 IQR, interquartile range In cases of children with anaphylaxis, the median total ambulance transport time was 31 min, with no significant difference from that for adults (median, 32 min, p=0.41). The median time from the emergency call to arrival at the site (children: 7 min vs. adults: 8 min; p<0.01), median time of stay at the site (children: 7 min vs. adults: 10 min; p<0.01), and median time from departure from the site to hospital arrival (children: 16 min vs. adults: 11 min; p<0.01) were significantly different between children and adults. Results of the multiple linear regression analysis for total ambulance transport time and time from site departure to hospital arrival are shown in Tables 2 and 3. These analyses revealed that when the patients were children, the total ambulance transport time remained the same (β = -0.65, 95% C.I. -3.17 to 1.88, p=0.62), but the time from site departure to hospital arrival was longer (β = 4.47, 95% C.I. 2.59 to 6.35, p<0.01). For transport from Kochi City, both the total ambulance transport time (β = -7.92, 95% C.I. -9.99 to -5.84, p<0.01) and the time from site departure to hospital arrival (β = -9.98, 95% C.I. -11.53 to -8.44, p<0.01) were shorter. Table 2. Results of m ultiple linear regression analysis for total ambulance transport time β (95% confidence interval) p-value Age Adults (Age ≥15 years) 1.00 (reference) Pediatrics (Age <15 years) -0.65 (-3.17 to 1.88) 0.62 Sex Female 1.00 (reference) Male 0.99 (-1.07 to 3.05) 0.35 Disposition Not mild 1.00 (reference) Hospitalization 0.13 (-1.92 to 2.18) 0.90 Department Kochi City -7.92 (-9.99 to -5.84) <0.01 Others 1.00 (reference) 1.00 (reference) Table 3 . Results of m ultiple linear regression analysis for time from site departure to hospital arrival β (95% confidence interval) p-value Age Adults (Age ≥15 years) 1.00 (reference) Pediatrics (Age <15 years) 4.47 (2.59 to 6.35) <0.01 Sex Female 1.00 (reference) Male 0.68 (-0.86 to 2.22) 0.38 Disposition Not mild 1.00 (reference) Hospitalization 0.16 (-1.35 to 1.69) 0.83 Department Kochi City -9.98 (-11.53 to -8.44) <0.01 Others 1.00 (reference) 1.00 (reference) DISCUSSION In this study, we compared the emergency transportation times between children and adults with anaphylaxis. There was no difference in total emergency transport time between children and adults, but when comparing each specific time point, there were significant differences in the time from the emergency call to arrival at the site, stay at the site, and time from site departure to hospital arrival. From the emergency call to arrival at the site, the time difference between children and adults was 1 min; therefore, clinical differences would be scant. The time spent at the site was 3 min shorter for children than for adults. One factor that could contribute to this is the rotational pediatric shift. Children’s hospitals in the Kochi City area are on a rotational pediatric shift, and patients must visit the hospital on-duty after hours. Therefore, it is possible that even for emergency transportation, the hospital selection process took less time, and the time spent in the area was shorter. A previous study reported that most children did not receive medications or procedures from the emergency medical service team, except for oxygen administration.[ 11 ] One possible reason for the shorter time spent on-site could be the absence of medication administration or medical procedures at the scene of the emergency. The greatest difference was observed in the time from site departure to hospital arrival, where the duration was 5 min longer for children than for adults. There are 41 emergency hospitals in Kochi Prefecture, but only seven are able to provide emergency care for children. In other words, the number of hospitals that emergency teams can choose from is smaller for children than for adults. Therefore, emergency pediatric patients may be transported to distant hospitals. Although most of the children in this study were in Kochi City—which should have provided better access to hospitals—the transportation duration was longer. The 5-min difference could be fatal in the event of airway obstruction. In fatal reactions to anaphylaxis, the median time to respiratory and cardiopulmonary arrest has been reported as 5 min for drugs, 15 min for bee stings, and 30 min for food.[ 7 ] Reducing transport time is important as early administration of adrenaline may reduce the risk of conversion[ 12 ] and prevent delayed reactions.[ 13 ] Despite having the small number of pediatric emergency hospitals in Kochi City, there was no difference in total emergency transport time between children and adults, even though children had shorter on-site stays. These findings suggest that the rotational pediatric shifts at these hospitals are relatively effective. The most common age group in this study was 65–69 years followed by 0–4 years. Most cases of anaphylaxis have been reported in children aged < 5 years.[ 4 , 14 ] In Japan, emergency life-saving technicians have been allowed to administer prescribed AAIs under medical control since 2009. However, AAIs were most often administered to children by their mothers and rarely by emergency life-saving technicians in Japan.[ 15 ] Another study on children with anaphylaxis reported that the reason AAIs could not be administered in the prehospital setting was the lack of prescriptions.[ 16 ] Therefore, increased AAI prescriptions for children may allow for early adrenaline administration. Alternatively, requesting transport via a doctor’s car may be a solution as it allows the doctor to administer adrenaline as early as possible. The strength of this study lies in the fact that the ambulance teams use dedicated tablets to accurately record various time points, including total transport time, the time from the emergency call to arrival at the site, time spent at the site, and time from site departure to hospital arrival. This detailed time recording made this study possible and constitutes one of its major strengths. Limitations This study had some limitations. First, it was conducted within the Kochi Prefecture and was likely influenced by the local emergency transport system. However, similar studies have not been conducted in the past and this study is therefore valuable. Second, the causative agent triggering the allergy was unknown because personal information on each emergency call could not be obtained. Treatment in a prehospital setting, such as AAI use, was not considered. Finally, the present results were a soft outcome of time since there were no deaths. The mortality rate for anaphylaxis is low, estimated at 0.05–0.51 per million persons/year for anaphylaxis due to drugs, 0.03–0.32 for food, and 0.09–0.13 for poison.[ 1 ] Therefore, it is not possible to compare prognoses in the present study. However, a difference of 5 min indicates that in case of a fatal reaction, there may be a crucial delay in saving lives; therefore, there is room for improvement. CONCLUSIONS In conclusion, in this observational study, there was no significant difference found in total transport time between children and adult patients with anaphylaxis. However, the duration from site departure to hospital arrival was 5 min longer for children than for adults; therefore, there is potential for improvement. Consequently, further nationwide studies are warranted. Abbreviations AAI: Adrenaline auto-injector Declarations Ethics approval and consent to participate This study was approved by the Ethical Review Committee of Kochi University School of Medicine (no. 2021-142). Informed consent was obtained in the form of an opt-out clause on the Kochi-Iryo-Net’s website. Consent for publication Not applicable Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available because there are restrictions due to contracts with Kochi Prefecture for data security, which allow access to external researchers only for research monitoring purposes. They may be available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was funded by The Morinaga Foundation for Health & Nutrition. The funding source had no role in the design, practice, or analysis of this study. Authors' contributions A.T. designed this study; S.T. performed the statistical analysis; A.T. and S.T. drafted the manuscript; M.M., T.O., K.N., and M.F. gave technical support and conceptual advice. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. A cknowledgements The authors are greatly indebted to all of the emergency management system personnel of the Kochi Municipal Fire Department. We thank our colleagues from the Kochi University Disaster and Emergency Medicine and the Department of Health Policy of the Kochi Prefectural Government for providing insights and expertise regarding our research. References Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13:100472. Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández Rivas M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69:1026-45. Ebisawa M, Ito K, Fujisawa T, Committee for Japanese Pediatric Guideline for Food Allergy, The Japanese Society of Pediatric Allergy and Clinical Immunology, Japanese Society of Allergology. Japanese guidelines for food allergy 2020. Allergol Int. 2020;69:370-86. Panesar SS, Javad S, de Silva D, Nwaru BI, Hickstein L, Muraro A, et al. The epidemiology of anaphylaxis in Europe: a systematic review. Allergy. 2013;68:1353-61. Wood RA, Camargo CA, Jr., Lieberman P, Sampson HA, Schwartz LB, Zitt M, et al. Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. J Allergy Clin Immunol. 2014;133:461-7. Wang Y, Allen KJ, Suaini NHA, McWilliam V, Peters RL, Koplin JJ. The global incidence and prevalence of anaphylaxis in children in the general population: A systematic review. Allergy. 2019;74:1063-80. Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy. 2000;30:1144-50. Motomura C, Okabe K, Matsuzaki H, Kawano T, Akamine Y, Yasunari D, et al. Changes in clinical features of food-related anaphylaxis in children during 5 years. Asia Pac Allergy. 2022;12:e14. Kochi Prefecture. 2024 Census in Kochi Prefecture. https://www.pref.kochi.lg.jp/doc/t-suikei/. Accessed 15 Dec 2024. Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013;48:452-8. McManus K, Finlay E, Palmer S, Anders JF, Hendry P, Fishe JN. A statewide analysis of EMS' pediatric transport destination decisions. Prehosp Emerg Care. 2020;24:672-82. Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;327:380-4. Liu X, Lee S, Lohse CM, Hardy CT, Campbell RL. Biphasic reactions in emergency department anaphylaxis patients: a prospective cohort study. J Allergy Clin Immunol Pract. 2020;8:1230-8. Tejedor Alonso MA, Moro Moro M, Mugica Garcia MV. Epidemiology of anaphylaxis. Clin Exp Allergy. 2015;45:1027-39. Ito K, Ono M, Kando N, Matsui T, Nakagawa T, Sugiura S, et al. Surveillance of the use of adrenaline auto-injectors in Japanese children. Allergol Int. 2018;67:195-200. Ninchoji T, Iwatani S, Nishiyama M, Kamiyoshi N, Taniguchi-Ikeda M, Morisada N, et al. Current situation of treatment for anaphylaxis in a Japanese pediatric emergency center. Pediatr Emerg Care. 2018;34:e64-e7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5647576","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":391378441,"identity":"37bf4e2f-946d-4ad9-8c6b-3490933e70dc","order_by":0,"name":"Aina Takeuchi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIie2QMUvEMBiG3xBol8CtEcH+hYYb7FDqX2koxOXAH6BwB0JcDt3k4PwRjroVAnUpuNZRBF0zHSeCmBYRh7Y6CuYZQsjLw/t9ATyePwhZuCPvrgFgSyCm36MxhTmFrH6jfNEqlLXKT4PRy5LYx5sMB2Eln9I6jfZDBBwnGei6v4asc8plXYAxZaazRonb01apCpCrckA5slxqOl/iUO/OrMljM9lwBKXbLB9s2Uo9B5u8nL0lndK2vI8qgWsxYFxVFM2nQvS4kkh9B9Y8FzvLWolrA5rI84IN7SLcYA+v+hjhhRJ2W6VRfF+Sxm6yPTHwY6L/2Y3ExKo3QtT/3EV8OPN4PJ5/xQdxulgQh6jebAAAAABJRU5ErkJggg==","orcid":"","institution":"Kochi University","correspondingAuthor":true,"prefix":"","firstName":"Aina","middleName":"","lastName":"Takeuchi","suffix":""},{"id":391378442,"identity":"3acdf9f6-0559-44a6-b9ab-bc73c4b39ecd","order_by":1,"name":"Shinya Takeuchi","email":"","orcid":"","institution":"Kochi University","correspondingAuthor":false,"prefix":"","firstName":"Shinya","middleName":"","lastName":"Takeuchi","suffix":""},{"id":391378443,"identity":"a7eb2040-0c05-429e-8a3b-d8305d09922b","order_by":2,"name":"Marina Minami","email":"","orcid":"","institution":"Kochi University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Marina","middleName":"","lastName":"Minami","suffix":""},{"id":391378444,"identity":"10678ab8-4ad4-42ff-a81a-e34fbc305967","order_by":3,"name":"Taku Oishi","email":"","orcid":"","institution":"Kochi University","correspondingAuthor":false,"prefix":"","firstName":"Taku","middleName":"","lastName":"Oishi","suffix":""},{"id":391378445,"identity":"920754df-b406-445a-aeb0-a64785f222c8","order_by":4,"name":"Kingo Nishiyama","email":"","orcid":"","institution":"Kochi University","correspondingAuthor":false,"prefix":"","firstName":"Kingo","middleName":"","lastName":"Nishiyama","suffix":""},{"id":391378446,"identity":"504f1fd1-ffd0-4cd7-b2d8-867e600f5aa4","order_by":5,"name":"Mikiya Fujieda","email":"","orcid":"","institution":"Kochi University","correspondingAuthor":false,"prefix":"","firstName":"Mikiya","middleName":"","lastName":"Fujieda","suffix":""}],"badges":[],"createdAt":"2024-12-15 13:08:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5647576/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5647576/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72286748,"identity":"90b2c853-79b8-43d2-a1f7-33af3f8cc522","added_by":"auto","created_at":"2024-12-24 17:06:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":153018,"visible":true,"origin":"","legend":"\u003cp\u003eSelection of ambulance transportation of patients with anaphylaxis\u003c/p\u003e\n\u003cp\u003ePatients were included between April 1, 2015 and March 31, 2021.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5647576/v1/3c8df60282ea310f30d4c26a.png"},{"id":72286747,"identity":"ee59308c-5277-45ea-9009-028c4c18b134","added_by":"auto","created_at":"2024-12-24 17:06:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":85806,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of patients with anaphylaxis transported by ambulance by age category\u003c/p\u003e\n\u003cp\u003eThe ages are categorized in 5-year increments, as per the data provided by the Kochi Prefecture\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5647576/v1/43789d3004578e0547802394.png"},{"id":72292456,"identity":"614b7ef2-a9d9-4fb5-86ba-5844d6bfcbac","added_by":"auto","created_at":"2024-12-24 17:39:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":665508,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5647576/v1/4a91f16a-a0b5-4c02-81d3-2df0e7cd23b7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ambulance transport times for children and adult patients with anaphylaxis: A retrospective analysis","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eAnaphylaxis is a fatal condition that can result in respiratory or cardiac arrest.[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] The lifetime prevalence of anaphylaxis is estimated to be 0.3\u0026ndash;5.1%.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] In children, the incidence of anaphylaxis is reported to be 1\u0026ndash;761 per 100,000 person-years.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] In the early stages of anaphylaxis, it is difficult to predict the speed of progression and eventual severity, and death may occur within minutes.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Therefore, it is important to shorten the time from the emergency call to hospital arrival as much as possible.\u003c/p\u003e \u003cp\u003eThe treatment for anaphylaxis is early intramuscular injection of adrenaline. In Japan, the rate of adrenaline autoinjectors (AAIs) or administered by others increased from 7% in 2013 to 27% in 2018,[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] although most patients were not administered adrenaline before hospital admission. Furthermore, it may be difficult to accept a case of a child with anaphylaxis as an emergency in a general hospital because the dose of adrenaline varies depending on body weight. Therefore, emergency transportation acceptance of these cases may take longer than that for adults. Particularly in rural areas, access to a central location may take longer, further delaying responses.\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, no studies have compared the time required to transport children with anaphylaxis to the emergency department with that of adults. Furthermore, no studies have compared the temporal segments within the transport process for anaphylaxis cases, such as the time from emergency call to arrival at the site, the duration of stay at the site, and the period from departure from the site to hospital arrival. Therefore, in this study, we compared the time required for emergency transportation between children and adults with anaphylaxis.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective observational study used data from the Kochi-Iryo-Net, Kochi Prefecture\u0026rsquo;s emergency medical and wide-area disaster information systems. The Kochi Prefecture is a rural area in Japan with a total population of 655,698 (2024 census) and an area of 7,104 square kilometers.[9] It accounts for 1.9% of Japan\u0026rsquo;s total land area and has an elongated fan-shaped topography facing the Pacific Ocean in the southern half of Shikoku, with a coastline extending 713 km from East to West. To the North, the Shikoku Mountains are made up of steep mountain ranges over 1,000 m high, and forested areas account for 84% of the prefecture\u0026rsquo;s total land area. In the center, 47.8% of the population lives in Kochi City, with 10.7% aged \u0026lt;15 years.\u003csup\u003e9\u0026nbsp;\u003c/sup\u003eWhen the ambulance team transports patients to the emergency department, the team enters the information into the Kochi-Iryo-Net database. The ambulance teams use dedicated tablets to accurately record various time points, including the total transport time, the time from the emergency call to arrival at the site, time spent at the site, and time from site departure to hospital arrival. The medical institution\u0026rsquo;s destination, severity, and up to three diagnoses are recorded by the physician who treats the patient. All data are compiled by the Kochi Prefecture. We extracted data on emergency transport from the Kochi-Iryo-Net database.\u003c/p\u003e\n\u003cp\u003eThe study period was from April 1, 2015 to March 31, 2021. Patients diagnosed with anaphylaxis were included in the study. We defined children as those aged \u0026lt;15 years. The ages were categorized into 5-year increments as per the data provided by the Kochi Prefecture. Patients with missing data were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and measurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome measure was the total time required for ambulance transportation, defined as the time from the emergency call to hospital arrival. The secondary outcomes were the duration of the time from the emergency call to arrival at the site, stay at the site, and time from site departure to hospital arrival. We investigated patient characteristics such as sex, illness severity, and location of ambulance departments. Illness severity was classified as either hospitalization or non-hospitalization. The locations of the ambulance departments were categorized as Kochi City (the most urban area) or others.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe median and interquartile range were calculated for each time point, and the number of cases and percentages were calculated for the nominal variables. As the data were non-normally distributed, Mann\u0026ndash;Whitney U tests were used to compare each time point. The Fisher\u0026rsquo;s exact test was used to compare group differences in sex distribution, ambulance department, and severity of illness.\u003c/p\u003e\n\u003cp\u003eMultiple linear regression analysis for the primary outcome and outcomes with statistically and clinically significant differences was performed to identify factors influencing patient characteristics. Clinically significant differences in terms of time were defined as at least 5 min based on a previous study.[7] The independent variables were children (adults as the reference), location of ambulance department (others as the reference), sex (female as the reference), and illness severity (non-hospitalization as the reference). Independent variables were selected based on a priori hypotheses.\u003c/p\u003e\n\u003cp\u003eStatistical significance was set at a two-tailed p-value of \u0026lt;0.05. All data analyses were performed using EZR software, V.1.33 (Saitama Medical Center, Jichi Medical University, Saitama, Japan), which is a graphical user interface for R (The R Foundation for Statistical Computing, Vienna, Austria). Specifically, it is a modified version of the R commander designed to add statistical functions frequently used in biostatistics.[10]\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDuring the 6-year study period, 242,332 ambulance transportations and 805 anaphylactic cases were recorded. We excluded eight cases with missing data; thus, data of 797 cases were extracted for analysis (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe ambulance transport characteristics during this period are listed in Table 1. During the study period, 155 children (19.4%) were transported because of anaphylaxis. There were no deaths owing to anaphylaxis. The severity of illness and sex were not significantly different between the children and adults. However, the prevalence of transport from Kochi City was significantly higher for children than for adults (47.1% vs. 37.2%; p=0.03). The most prevalent age group in this study was 65\u0026ndash;69 years followed by 0\u0026ndash;4 years (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e. Characteristics of ambulance transport for anaphylaxis during the study period\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"557\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003ePediatric patients\u003c/p\u003e\n \u003cp\u003e(Age \u0026lt;15 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eAdult patients\u003c/p\u003e\n \u003cp\u003e(Age \u0026ge;15 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eSex, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003e\u0026nbsp;Male\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e97 (62.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e378 (58.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eDisposition, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003e\u0026nbsp;hospitalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e94 (60.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e176 (63.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eDepartment, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003e\u0026nbsp;Kochi City\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e73 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e239 (37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eTransport time, min (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003e\u0026nbsp;Total transport time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e31 (25\u0026ndash;39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e32 (25\u0026ndash;43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eTime from emergency call\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eto arrival at the site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e7 (5\u0026ndash;9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e8 (6\u0026ndash;11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eTime to stay at the site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e7 (5\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e10 (7\u0026ndash;14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003eTime from the site departure\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eto the hospital arrival\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e16 (11\u0026ndash;22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e11 (6\u0026ndash;19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIQR, interquartile range\u003c/p\u003e\n\u003cp\u003eIn cases of children with anaphylaxis, the median total ambulance transport time was 31 min, with no significant difference from that for adults (median, 32 min, p=0.41). The median time from the emergency call to arrival at the site (children: 7 min vs. adults: 8 min; p\u0026lt;0.01), median time of stay at the site (children: 7 min vs. adults: 10 min; p\u0026lt;0.01), and median time from departure from the site to hospital arrival (children: 16 min vs. adults: 11 min; p\u0026lt;0.01) were significantly different between children and adults.\u003c/p\u003e\n\u003cp\u003eResults of the multiple linear regression analysis for total ambulance transport time and time from site departure to hospital arrival are shown in Tables 2 and 3. These analyses revealed that when the patients were children, the total ambulance transport time remained the same (\u0026beta; = -0.65, 95% C.I. -3.17 to 1.88, p=0.62), but the time from site departure to hospital arrival was longer (\u0026beta; = 4.47, 95% C.I. 2.59 to 6.35, p\u0026lt;0.01). For transport from Kochi City, both the total ambulance transport time (\u0026beta; = -7.92, 95% C.I. -9.99 to -5.84, p\u0026lt;0.01) and the time from site departure to hospital arrival (\u0026beta; = -9.98, 95% C.I. -11.53 to -8.44, p\u0026lt;0.01) were shorter.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Results of m\u003c/strong\u003e\u003cstrong\u003eultiple linear regression analysis for total ambulance transport time\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"550\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026beta; (95% confidence interval)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Adults\u003c/p\u003e\n \u003cp\u003e(Age \u0026ge;15 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e1.00 (reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Pediatrics\u003c/p\u003e\n \u003cp\u003e(Age \u0026lt;15 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e-0.65 (-3.17 to 1.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e1.00 (reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e0.99 (-1.07 to\u0026nbsp;3.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eDisposition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Not mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e1.00 (reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Hospitalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e0.13 (-1.92 to 2.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eDepartment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Kochi City\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e-7.92 (-9.99 to -5.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e1.00 (reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1.00 (reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e. Results of m\u003c/strong\u003e\u003cstrong\u003eultiple linear regression analysis for time from site departure to hospital arrival\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"550\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026beta; (95% confidence interval)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Adults\u003c/p\u003e\n \u003cp\u003e(Age \u0026ge;15 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e1.00 (reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Pediatrics\u003c/p\u003e\n \u003cp\u003e(Age \u0026lt;15 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e4.47 (2.59 to 6.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e1.00 (reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e0.68 (-0.86\u0026nbsp;to 2.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eDisposition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Not mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e1.00 (reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Hospitalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e0.16 (-1.35 to 1.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003eDepartment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Kochi City\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e-9.98 (-11.53 to -8.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e1.00 (reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1.00 (reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, we compared the emergency transportation times between children and adults with anaphylaxis. There was no difference in total emergency transport time between children and adults, but when comparing each specific time point, there were significant differences in the time from the emergency call to arrival at the site, stay at the site, and time from site departure to hospital arrival.\u003c/p\u003e \u003cp\u003eFrom the emergency call to arrival at the site, the time difference between children and adults was 1 min; therefore, clinical differences would be scant. The time spent at the site was 3 min shorter for children than for adults. One factor that could contribute to this is the rotational pediatric shift. Children\u0026rsquo;s hospitals in the Kochi City area are on a rotational pediatric shift, and patients must visit the hospital on-duty after hours. Therefore, it is possible that even for emergency transportation, the hospital selection process took less time, and the time spent in the area was shorter. A previous study reported that most children did not receive medications or procedures from the emergency medical service team, except for oxygen administration.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] One possible reason for the shorter time spent on-site could be the absence of medication administration or medical procedures at the scene of the emergency.\u003c/p\u003e \u003cp\u003eThe greatest difference was observed in the time from site departure to hospital arrival, where the duration was 5 min longer for children than for adults. There are 41 emergency hospitals in Kochi Prefecture, but only seven are able to provide emergency care for children. In other words, the number of hospitals that emergency teams can choose from is smaller for children than for adults. Therefore, emergency pediatric patients may be transported to distant hospitals. Although most of the children in this study were in Kochi City\u0026mdash;which should have provided better access to hospitals\u0026mdash;the transportation duration was longer. The 5-min difference could be fatal in the event of airway obstruction. In fatal reactions to anaphylaxis, the median time to respiratory and cardiopulmonary arrest has been reported as 5 min for drugs, 15 min for bee stings, and 30 min for food.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Reducing transport time is important as early administration of adrenaline may reduce the risk of conversion[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and prevent delayed reactions.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDespite having the small number of pediatric emergency hospitals in Kochi City, there was no difference in total emergency transport time between children and adults, even though children had shorter on-site stays. These findings suggest that the rotational pediatric shifts at these hospitals are relatively effective.\u003c/p\u003e \u003cp\u003eThe most common age group in this study was 65\u0026ndash;69 years followed by 0\u0026ndash;4 years. Most cases of anaphylaxis have been reported in children aged\u0026thinsp;\u0026lt;\u0026thinsp;5 years.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] In Japan, emergency life-saving technicians have been allowed to administer prescribed AAIs under medical control since 2009. However, AAIs were most often administered to children by their mothers and rarely by emergency life-saving technicians in Japan.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Another study on children with anaphylaxis reported that the reason AAIs could not be administered in the prehospital setting was the lack of prescriptions.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Therefore, increased AAI prescriptions for children may allow for early adrenaline administration. Alternatively, requesting transport via a doctor\u0026rsquo;s car may be a solution as it allows the doctor to administer adrenaline as early as possible.\u003c/p\u003e \u003cp\u003eThe strength of this study lies in the fact that the ambulance teams use dedicated tablets to accurately record various time points, including total transport time, the time from the emergency call to arrival at the site, time spent at the site, and time from site departure to hospital arrival. This detailed time recording made this study possible and constitutes one of its major strengths.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study had some limitations. First, it was conducted within the Kochi Prefecture and was likely influenced by the local emergency transport system. However, similar studies have not been conducted in the past and this study is therefore valuable. Second, the causative agent triggering the allergy was unknown because personal information on each emergency call could not be obtained. Treatment in a prehospital setting, such as AAI use, was not considered. Finally, the present results were a soft outcome of time since there were no deaths. The mortality rate for anaphylaxis is low, estimated at 0.05\u0026ndash;0.51 per million persons/year for anaphylaxis due to drugs, 0.03\u0026ndash;0.32 for food, and 0.09\u0026ndash;0.13 for poison.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Therefore, it is not possible to compare prognoses in the present study. However, a difference of 5 min indicates that in case of a fatal reaction, there may be a crucial delay in saving lives; therefore, there is room for improvement.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIn conclusion, in this observational study, there was no significant difference found in total transport time between children and adult patients with anaphylaxis. However, the duration from site departure to hospital arrival was 5 min longer for children than for adults; therefore, there is potential for improvement. Consequently, further nationwide studies are warranted.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAAI: Adrenaline auto-injector\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethical Review Committee of Kochi University School of Medicine (no. 2021-142). Informed consent was obtained in the form of an opt-out clause on the Kochi-Iryo-Net\u0026rsquo;s website.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available because there are restrictions due to contracts with Kochi Prefecture for data security, which allow access to external researchers only for research monitoring purposes. They may be available from the corresponding author on reasonable request.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by The Morinaga Foundation for Health \u0026amp; Nutrition. The funding source had no role in the design, practice, or analysis of this study.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA.T. designed this study; S.T. performed the statistical analysis; A.T. and S.T. drafted the manuscript; M.M., T.O., K.N., and M.F. gave technical support and conceptual advice. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003cstrong\u003ecknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are greatly indebted to all of the emergency management system personnel of the Kochi Municipal Fire Department. We thank our colleagues from the Kochi University Disaster and Emergency Medicine and the Department of Health Policy of the Kochi Prefectural Government for providing insights and expertise regarding our research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13:100472.\u003c/li\u003e\n\u003cli\u003eMuraro A, Roberts G, Worm M, Bil\u0026ograve; MB, Brockow K, Fern\u0026aacute;ndez Rivas M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69:1026-45.\u003c/li\u003e\n\u003cli\u003eEbisawa M, Ito K, Fujisawa T, Committee for Japanese Pediatric Guideline for Food Allergy, The Japanese Society of Pediatric Allergy and Clinical Immunology, Japanese Society of Allergology. Japanese guidelines for food allergy 2020. Allergol Int. 2020;69:370-86.\u003c/li\u003e\n\u003cli\u003ePanesar SS, Javad S, de Silva D, Nwaru BI, Hickstein L, Muraro A, et al. The epidemiology of anaphylaxis in Europe: a systematic review. Allergy. 2013;68:1353-61.\u003c/li\u003e\n\u003cli\u003eWood RA, Camargo CA, Jr., Lieberman P, Sampson HA, Schwartz LB, Zitt M, et al. Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. J Allergy Clin Immunol. 2014;133:461-7.\u003c/li\u003e\n\u003cli\u003eWang Y, Allen KJ, Suaini NHA, McWilliam V, Peters RL, Koplin JJ. The global incidence and prevalence of anaphylaxis in children in the general population: A systematic review. Allergy. 2019;74:1063-80.\u003c/li\u003e\n\u003cli\u003ePumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy. 2000;30:1144-50.\u003c/li\u003e\n\u003cli\u003eMotomura C, Okabe K, Matsuzaki H, Kawano T, Akamine Y, Yasunari D, et al. Changes in clinical features of food-related anaphylaxis in children during 5 years. Asia Pac Allergy. 2022;12:e14.\u003c/li\u003e\n\u003cli\u003eKochi Prefecture. 2024 Census in Kochi Prefecture. https://www.pref.kochi.lg.jp/doc/t-suikei/. Accessed 15 Dec 2024.\u003c/li\u003e\n\u003cli\u003eKanda Y. Investigation of the freely available easy-to-use software \u0026apos;EZR\u0026apos; for medical statistics. Bone Marrow Transplant. 2013;48:452-8.\u003c/li\u003e\n\u003cli\u003eMcManus K, Finlay E, Palmer S, Anders JF, Hendry P, Fishe JN. A statewide analysis of EMS\u0026apos; pediatric transport destination decisions. Prehosp Emerg Care. 2020;24:672-82.\u003c/li\u003e\n\u003cli\u003eSampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;327:380-4.\u003c/li\u003e\n\u003cli\u003eLiu X, Lee S, Lohse CM, Hardy CT, Campbell RL. Biphasic reactions in emergency department anaphylaxis patients: a prospective cohort study. J Allergy Clin Immunol Pract. 2020;8:1230-8.\u003c/li\u003e\n\u003cli\u003eTejedor Alonso MA, Moro Moro M, Mugica Garcia MV. Epidemiology of anaphylaxis. Clin Exp Allergy. 2015;45:1027-39.\u003c/li\u003e\n\u003cli\u003eIto K, Ono M, Kando N, Matsui T, Nakagawa T, Sugiura S, et al. Surveillance of the use of adrenaline auto-injectors in Japanese children. Allergol Int. 2018;67:195-200.\u003c/li\u003e\n\u003cli\u003eNinchoji T, Iwatani S, Nishiyama M, Kamiyoshi N, Taniguchi-Ikeda M, Morisada N, et al. Current situation of treatment for anaphylaxis in a Japanese pediatric emergency center. Pediatr Emerg Care. 2018;34:e64-e7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anaphylaxis, Children, Japan, Ambulances, Transportation of Patients","lastPublishedDoi":"10.21203/rs.3.rs-5647576/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5647576/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAnaphylaxis is a fatal condition that can cause respiratory or cardiac arrest within 30 min. Therefore, it is important to shorten the time from the emergency call to hospital arrival as much as possible. However, children with anaphylaxis in rural areas may require more time for ambulance transport than do adults because of the lack of nearby pediatric medical facilities. Thus, we aimed to compare ambulance transport times between children and adults with anaphylaxis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective observational study used data from the Kochi-Iryo-Net database. We included patients with anaphylaxis who were transported to the emergency department between April 1, 2015 and March 31, 2021. Children were defined as those aged\u0026thinsp;\u0026lt;\u0026thinsp;15 years. The primary outcome measure was the total time required for ambulance transportation. To adjust for patient background, we performed multiple linear regression analyses of the outcomes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDuring the study period, 797 patients with anaphylaxis were transported to the emergency department, among whom 155 (19.4%) were children. There was no significant difference in the total ambulance transport time (children: 31 min vs. adults: 32 min, p\u0026thinsp;=\u0026thinsp;0.41). However, the time from site departure to hospital arrival was 5 min longer for children (16 min vs. adults: 11 min, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWhile no significant difference was observed in the total transport time between children and adult patients with anaphylaxis, there may be potential to optimize the time from site departure to hospital arrival for pediatric cases.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003enot applicable.\u003c/p\u003e","manuscriptTitle":"Ambulance transport times for children and adult patients with anaphylaxis: A retrospective analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-24 17:06:53","doi":"10.21203/rs.3.rs-5647576/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"de0764e9-1df2-43a8-bb2c-591935009c0f","owner":[],"postedDate":"December 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-24T17:06:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-24 17:06:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5647576","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5647576","identity":"rs-5647576","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}