Management of status epilepticus in children prior to medical retrieval: Deviations from the guidelines

Abstract

Aim To evaluate the influence of adherence to treatment guidelines on outcomes in children presenting with status epilepticus (SE) using the Newborn and Paediatric Emergency Transport Service, New South Wales prospective registry. Methods We reviewed the treatment of children with SE, transported by the Newborn And Paediatric Emergency Transport Service to a tertiary paediatric hospital, over 1 year. We evaluated variation in management from the New South Wales clinical practice guideline. Results There was excessive administration of benzodiazepines (BZD) and a delay in administration of appropriate second‐line treatment of status (median 45 min). There was excessive use of BZD, with five or more doses of BZD associated with significantly higher odds for intubation. Conclusion There is considerable scope to improve clinician compliance with the SE clinical practice guidelines.

Status Epilepticus Diagnostic and Management Approach in Emergency Department

“…To ensure an open airway, the patient's head must be positioned and at any time it may be necessitated to initiate rapid sequence intubation (Uppal et al, 2019). The most common antiepileptic drug are benzodiazepines are.…”

“…, A repeat dose may be administered 3 to 5 minutes later, If seizures do not resolve. Intravenous administration is preferred (Uppal et al, 2019). Antiepileptic drugs should be given together with benzodiazepines.…”

“…Antiepileptic drugs should be given together with benzodiazepines. The clinician can choose from levetiracetam (40 to 60 mg/kg up to a total of 4500 mg over 15 minutes), fosphenytoin phenytoin (20 mg/kg up to 25 to 50 mg/minute), (20 mg/kg phenytoin equivalents [PE] up to 100 to 150 PE/minute), and valproic acid (30mg/kg at up to 10 mg/kg/minute but with raised concerns on children under two years as there is a risk of hepatotoxicity) (Uppal et al, 2019). If the seizure does not abort after the second dose of benzodiazepines, it must be treated as refractory status epilepticus.…”

Evaluation of adherence to pediatric status epilepticus management guidelines in Saudi Arabia

“…9,14 Our findings are in line with those of previous studies regarding this matter. [15][16][17][18][19][20][21][22] Administering sub-optimal doses of the antiepileptics, especially benzodiazepines, is common in the management of pediatric SE. In a prospective observational study of 100 treated patients of SE requiring ICU admission, 22.5% received benzodiazepine dose outside weight-based dose.…”