Emergency management of pediatric convulsive status epilepticus - A multicenter study of 542 patients

Lewena, Stuart, Pennington, Victoria, Acworth, Jason, Thornton, Susan, Ngo, Peter, McIntyre, Shona, Krieser, David, Neutze, Jocelyn and Speldewinde, Deirdre (2009) Emergency management of pediatric convulsive status epilepticus - A multicenter study of 542 patients. Pediatric Emergency Care, 25 2: 83-87. doi:10.1097/PEC.0b013e318196ea6e


Author Lewena, Stuart
Pennington, Victoria
Acworth, Jason
Thornton, Susan
Ngo, Peter
McIntyre, Shona
Krieser, David
Neutze, Jocelyn
Speldewinde, Deirdre
Title Emergency management of pediatric convulsive status epilepticus - A multicenter study of 542 patients
Journal name Pediatric Emergency Care   Check publisher's open access policy
ISSN 0749-5161
1535-1815
Publication date 2009-02
Year available 2009
Sub-type Article (original research)
DOI 10.1097/PEC.0b013e318196ea6e
Volume 25
Issue 2
Start page 83
End page 87
Total pages 5
Editor Stephen Ludwig
Gary Fleisher
Place of publication United States
Publisher Lippincott Williams & Wilkins
Collection year 2010
Language eng
Subject C1
920299 Health and Support Services not elsewhere classified
110305 Emergency Medicine
111403 Paediatrics
Abstract Objective: To perform a multicenter study examining the presentations and emergency management of children with convulsive status epilepticus (CSE) to sites within the Paediatric Research in Emergency Departments International Collaborative. Methods: Retrospective review of children presenting to emergency departments (EDs) with convulsive seizures of at least 10 minutes' duration. Eight sites within the Paediatric Research in Emergency Departments International Collaborative network in Australia and New Zealand participated. Patients were identified through a search of ED electronic records for the period January 2000 to December 2004. Results: Data were obtained from 542 eligible episodes of CSE. Demographics and seizure history were similar across all sites. One third of children with CSE presented with their first seizure. A preexisting diagnosis that predisposed to seizures was present in 59%. Median duration of seizures before hospitalization was 45 minutes, and median duration of treatment in ED before termination was 30 minutes. Prehospital duration did not seem to influence the timing of key ED interventions such as the administration of second-line anticonvulsants or progression to rapid sequence induction (RSI) of anesthesia and intubation. Convulsive status epilepticus was terminated after first-line treatment in 42%, second-line treatment in 35%, and RSI in 22%. One third of the patients had persistent seizure activity beyond 40 minutes of ED treatment. Marked variation in the use of RSI for refractory seizures was observed between sites. Conclusions: Convulsive status epilepticus is an important neurological emergency, with many children experiencing prolonged seizures in both the prehospital and hospital phases. Persistent seizure activity beyond 40 minutes contrasts with current published guidelines. There is a need to adopt a widely accepted approach to the management of children who fail to respond to standard anticonvulsant therapy.
Keyword seizure
treatment protocol
status epilepticus
treatment
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Thu, 03 Sep 2009, 08:39:39 EST by Mr Andrew Martlew on behalf of Paediatrics & Child Health - RBWH