Pediatric status epilepticus management by Emergency Medical Services (the pSERG cohort).
Seizure · 2023-07-16 · Observational study
Abstract
PURPOSE: Delayed treatment in status epilepticus (SE) is independently associated with increased treatment resistance, morbidity, and mortality. We describe the prehospital management pathway and Emergency Medical Services (EMS) timeliness in children who developed refractory convulsive status epilepticus (RCSE). METHODS: Retrospective multicenter study in the United States using prospectively collected observational data from June 2011 to March 2020. We selected pediatric patients (one month-21 years) with RCSE initiated outside the hospital and transported to the hospital by EMS. RESULTS: We included 91 patients with a median (percentile25-percentile75) age of 3.0 (1.5-7.3) years. The median time from seizure onset to hospital arrival was 45 (30-67) minutes, with a median time cared for by EMS of 24 (15-36) minutes. Considering treatment by caregivers and EMS before hospital arrival, 20 (22%) patients did not receive any anti-seizure medications (ASM) and 71 (78%) received one to five doses of benzodiazepines (BZD), without non-BZD ASM. We provided the prehospital treatment flow path of these patients through caregivers and EMS including relevant time points. Patients with a history of SE were more likely to receive the first BZD in the prehospital setting compared to patients without a history of SE (adjusted HR 3.25, 95% CI 1.72-6.12, p<0.001). CONCLUSION: In this multicenter study of pediatric RCSE, prehospital treatment may be streamlined further. Patients with a history of SE were more likely to receive prehospital rescue medication.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Time intervals · Sedatives & anxiolytics · Children · Other benzodiazepines & Z-drugs
Related articles
- Association of guideline publication and delays to treatment in pediatric status epilepticus. (Neurology, 2020)
- Time from convulsive status epilepticus onset to anticonvulsant administration in children. (Neurology, 2015)
- Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population. (Epilepsia, 2015)
- Effect of treatment of convulsive status epilepticus on outcome in children. (Georgian Med News, 2014)
- Timing in the treatment of status epilepticus: From basics to the clinic. (Seizure, 2019)
- Consensus guidelines on management of childhood convulsive status epilepticus. (Indian Pediatr, 2014)