Faculty Collaboration Database

Association of guideline publication and delays to treatment in pediatric status epilepticus. Neurology 2020 Sep 01;95(9):e1222-e1235

Date

07/03/2020

Pubmed ID

32611646

Pubmed Central ID

PMC7538224

DOI

10.1212/WNL.0000000000010174

Scopus ID

2-s2.0-85090171140 (requires institutional sign-in at Scopus site)   17 Citations

Abstract

OBJECTIVE: To determine whether publication of evidence on delays in time to treatment shortens time to treatment in pediatric refractory convulsive status epilepticus (rSE), we compared time to treatment before (2011-2014) and after (2015-2019) publication of evidence of delays in treatment of rSE in the Pediatric Status Epilepticus Research Group (pSERG) as assessed by patient interviews and record review.

METHODS: We performed a retrospective analysis of a prospectively collected dataset from June 2011 to September 2019 on pediatric patients (1 month-21 years of age) with rSE.

RESULTS: We studied 328 patients (56% male) with median (25th-75th percentile [p₂₅-p₇₅]) age of 3.8 (1.3-9.4) years. There were no differences in the median (p₂₅-p₇₅) time to first benzodiazepine (BZD) (20 [5-52.5] vs 15 [5-38] minutes, p = 0.3919), time to first non-BZD antiseizure medication (68 [34.5-163.5] vs 65 [33-142] minutes, p = 0.7328), and time to first continuous infusion (186 [124.2-571] vs 160 [89.5-495] minutes, p = 0.2236). Among 157 patients with out-of-hospital onset whose time to hospital arrival was available, the proportion who received at least 1 BZD before hospital arrival increased after publication of evidence of delays (41 of 81 [50.6%] vs 57 of 76 [75%], p = 0.0018), and the odds ratio (OR) was also increased in multivariable logistic regression (OR 4.35 [95% confidence interval 1.96-10.3], p = 0.0005).

CONCLUSION: Publication of evidence on delays in time to treatment was not associated with improvements in time to treatment of rSE, although it was associated with an increase in the proportion of patients who received at least 1 BZD before hospital arrival.

Author List

Sánchez Fernández I, Abend NS, Amengual-Gual M, Anderson A, Arya R, Barcia Aguilar C, Brenton JN, Carpenter JL, Chapman KE, Clark J, Farias-Moeller R, Gaillard WD, Gaínza-Lein M, Glauser T, Goldstein J, Goodkin HP, Guerriero RM, Lai YC, McDonough T, Mikati MA, Morgan LA, Novotny E Jr, Payne E, Peariso K, Piantino J, Ostendorf A, Sands TT, Sannagowdara K, Tasker RC, Tchapyjnikov D, Topjian AA, Vasquez A, Wainwright MS, Wilfong A, Williams K, Loddenkemper T, pSERG

Author

Raquel Farias-Moeller MD Associate Professor in the Neurology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Anticonvulsants
Benzodiazepines
Cerebral Palsy
Child
Child, Preschool
Developmental Disabilities
Emergency Medical Services
Epilepsy
Evidence-Based Medicine
Female
Hospital Mortality
Hospitals, Pediatric
Humans
Infant
Infusions, Intravenous
Intellectual Disability
Intensive Care Units, Pediatric
Length of Stay
Male
Practice Guidelines as Topic
Professional Practice Gaps
Retrospective Studies
Status Epilepticus
Time-to-Treatment
Young Adult