Seizure Treatment in Children Transported to Tertiary Care: Recommendation Adherence and Outcomes

Abstract

Adherence to evidence-based recommended acute seizure treatment during initial care of pediatric patients using medical air transportation was poor. Intubation was more common when patients did not receive recommended acute seizure care. Educational efforts with a sustained quality focus should be directed to increase adherence to appropriate pediatric seizure treatment of children in community emergency departments.

Timing is everything: Where status epilepticus treatment fails

“…35 When benzodiazepines were administered, 22% (32 of 146) to 90% (159 of 176) of patients received suboptimal weight-based dosing. 22,25,26,28 …”

“…24 Another study demonstrated a relative risk of intubation of 2.3 (95% CI, 1.4–3.9; p = 0.002) for pediatric patients treated with >2 benzodiazepine doses. 28 …”

“…28 Delay in administering second-line therapy was correlated with delay in return of consciousness in adults with convulsive status epilepticus (odds ratio [OR], 0.295; 95% CI, 0.039–0.534; p = 0.027). 34 When considering functional outcome in adults presenting with status epilepticus, patients treated in the ED within 1 hour of seizure onset had better recovery than when treatment was initiated beyond 1 hour (82% vs 46%; p < 0.05).…”

“…24 Another study demonstrated a relative risk of intubation of 2.3 (95% CI, 1.4-3.9; p 5 0.002) for pediatric patients treated with >2 benzodiazepine doses. 28 Associations Between Time to Therapy and Seizure Cessation A positive relationship between seizure duration and delayed first-line, second-line, and/or third-line therapy was demonstrated for both pediatric and adult patients presenting with convulsive status epilepticus. 22,27,31,34,37 A correlation between seizure duration and treatment delay was also noted in a cohort of adult patients not limited to convulsive seizures.…”

“…22,25,26,28 Because of improper drug choice, dosage, or sequence, 29% (13 of 45) to 61% (77 of 126) of patients were not treated according to protocol. 24,28,33,36,37 A common violation of the protocol was more than two administrations of benzodiazepines (rather than the recommended escalation to a second-line drug), which was observed in 23% (41 of 179) to 49% (23 of 47) of pediatric patients 22,24,27,28 and may be associated with greater risk of respiratory depression. In one study, 43% (10 of 23) of pediatric patients treated with >2 doses of benzodiazepines had respiratory compromise compared to 13% (3 of 24) patients treated with 2 or fewer doses.…”