08-Prehospital and Emergency Department Management of Pediatric Status Epilepticus
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Pediatrics, Neuroscience, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Nicholas J. Regas


Introduction/Hypothesis: Status epilepticus (SE) is the most common medical neurological emergency in childhood and is associated with a significant risk of neurologic morbidity and mortality. The study aims to describe pre-hospital and emergency department (ED) management of pediatric SE. We hypothesized that greater than 15% of patients received inadequate dosing of first-line anti-seizure medication (benzodiazepines).

Methods: This single-center, retrospective study included 43 pediatric patients who presented between January 1, 2018 and May 1, 2020 to the ED of a tertiary medical center. Patients, ranging in age from 1 month to 18 years, with SE were included. We used the definition and dosing recommendations put forth by the Neurocritical Care Society 'Guidelines for Evaluation and Management of Status Epilepticus'. Sample percentages were compared to the hypothesized cutoff using z-tests for the one proportion.

Results: A total of 43 patients were included, among whom 22 (51%) were male. The median age was 1 (1 - 2) year. Eleven patients received a total of 13 doses of benzodiazepines by EMS, all of which (100%) were below the recommended dose. This was significantly greater than the 15% hypothesized cutoff (z = 7.90, p <.001, 95% CI = 71.5% - 100.0%). Thirteen patients received a total of 18 doses of benzodiazepines in the ED, of which 61% were inadequate. This was also significantly greater than the 15% cutoff (z = 5.48, p <.001, 95% CI = 35.7% - 82.7%). Intramuscular midazolam was the most frequently administered benzodiazepine (58%), with a median dose of 0.1 (0.09 - 0.12) mg/kg. We did not identify a relationship between inadequate benzodiazepine dose and hospital/ICU admission or the need for mechanical intubation likely due to our small sample size.

Conclusions: A significant percentage of pediatric SE patients received inadequate benzodiazepine dosing in the pre-hospital and ED setting (100% and 61%, respectively). This is concerning given the established relationship between inadequate and/or delayed treatment and increased mortality. The study results indicate the critical importance of establishing and adhering to treatment protocols for the management of pediatric SE. Further study is required to determine the short and long term outcomes associated with inadequate treatment of pediatric SE.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Neuroscience
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Seizure
Year 2021
Nicholas Regas
pediatric status epilepticus
emergency department
anti-epileptic drugs


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