Do epinephrine auto-injectors have an unsuitable needle length for young children?
Bibliographic record
Abstract
Epinephrine delivered by an auto-injector to the anterolateral aspect of the thigh is the standard of care for the emergency treatment of anaphylaxis. For most pediatric patients in Canada, the EpipenJr® is prescribed, which has a needle length of 12.7mm. The route of epinephrine administration affects its onset of action, and intramuscular delivery is recommended for rapid absorption. If epinephrine is injected subcutaneously, the absorption will be slower. Conversely, if it is injected into the bone, the absorption will be unpredictable. There are no published clinical studies assessing whether the needle length of the EpipenJr® is adequate to deliver epinephrine intramuscularly in pediatric patients at risk of anaphylaxis. Consecutive pediatric patients under 15kg with confirmed food allergy who required prescriptions or refills of EpipenJr® at an allergist’s office were included in this study. An ultrasound of the anterolateral aspect of the mid thigh was performed under minimal (min) and maximal (max) pressure. Measurements of skin-to-muscle depth (STMD) and skin-to-bone depth (STBD) were completed. Baseline characteristics between two patient groups were compared: patients with STBD max less than 12.7mm and patients with STBD max greater than or equal to 12.7mm. Multivariable linear regression was performed including variables such as age, sex, BMI and race. The likelihood of the STBD max of less than 12.7 mm was calculated for the weight groupings of <9kg,<11kg and <15kg. A total of 75 participants were included in this study. There were 21 patients (28%) that had STBD max less than 12.7mm. Baseline characteristics differed significantly for height and weight of the participants between the two groups (p<0.05). Multivariable linear regression showed that age (p=0.0002) and BMI (p=0.00008) were significantly associated with STBD max , following adjustment for sex and race. For patients under 9kg, 90% had STBD max less than 12.7mm. For patients under 11kg, 53% had STBD max less than 12.7mm. Based on this study, there are a significant number of children under 15kg at risk of receiving an epinephrine auto-injector into the bone. Because of this risk, epinephrine auto-injectors should be prescribed with caution in this population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".