Pediatric status epilepticus management by Emergency Medical Services (the pSERG cohort)

Marta Amengual-Gual, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Universitat de les Illes Balears, Palma, Spain.
Iván Sánchez Fernández, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Department of Child Neurology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
Alejandra Vasquez, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States.
Nicholas S. Abend, Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
Anne Anderson, Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.
Ravindra Arya, Division of Neurology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
Cristina Barcia Aguilar, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Department of Child Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
J Nicholas Brenton, Department of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, VA, United States.
Jessica L. Carpenter, Center for Neuroscience, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Kevin E. Chapman, Departments of Pediatrics and Neurology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States; Department of Pediatrics, University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.
Justice Clark, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
Raquel Farias-Moeller, Department of Neurology Division of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States.
William D. Gaillard, Center for Neuroscience, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Tracy A. Glauser, Division of Neurology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
Joshua L. Goldstein, Ruth D & Ken M Davee Pediatric Neurocritical Care Program, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Howard P. Goodkin, Department of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, VA, United States.
Yi-Chen Lai, Division of Pediatric Critical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.
Mohamad A. Mikati, Division of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, NC, United States.
Lindsey A. Morgan, Departments of Neurology and Pediatrics, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, WA, United States.
Edward J. Novotny, Departments of Neurology and Pediatrics, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, WA, United States.
Adam P. Ostendorf, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH, United States.
Eric T. Payne, Division of Neurology, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada.
Katrina Peariso, Division of Neurology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
Juan Piantino, Department of Pediatrics, Division Pediatric Neurology, Neuro-Critical Care Program, Oregon Health and Science University, Portland, OR, United States.
Latania Reece, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
James J. Riviello, Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.
Kumar Sannagowdara, Department of Neurology Division of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States.
Theodore Sheehan, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
Robert C. Tasker, Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
Dmitry Tchapyjnikov, Division of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, NC, United States.
Alexis A. Topjian, Departments of Anesthesia and Critical care Medicine and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
Mark S. Wainwright, Departments of Neurology and Pediatrics, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, WA, United States.

Document Type

Journal Article

Publication Date

7-16-2023

Journal

Seizure

Volume

111

DOI

10.1016/j.seizure.2023.07.010

Keywords

Emergency Medical Services (EMS); Epilepsy; Guidelines; Prehospital management; Status epilepticus; Treatment

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 (percentile-percentile) 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.

Department

Neurology

Link to Full Text

Share

COinS