Emergency management of paediatric status epilepticus in Australia and New Zealand: Practice patterns in the context of clinical practice guidelines

Babl, Franz E., Sheriff, Nisa, Borland, Meredith, Acworth, Jason, Neutze, Jocelyn, Krieser, David, Ngo, Peter, Schutz, Jacquie, Thomson, Fiona, Cotterell, Elizabeth, Jamison, Sarah and Francis, Peter (2009) Emergency management of paediatric status epilepticus in Australia and New Zealand: Practice patterns in the context of clinical practice guidelines. Journal of Paediatrics And Child Health, 45 9: 541-546. doi:10.1111/j.1440-1754.2009.01536.x


Author Babl, Franz E.
Sheriff, Nisa
Borland, Meredith
Acworth, Jason
Neutze, Jocelyn
Krieser, David
Ngo, Peter
Schutz, Jacquie
Thomson, Fiona
Cotterell, Elizabeth
Jamison, Sarah
Francis, Peter
Title Emergency management of paediatric status epilepticus in Australia and New Zealand: Practice patterns in the context of clinical practice guidelines
Journal name Journal of Paediatrics And Child Health   Check publisher's open access policy
ISSN 1034-4810
1440-1754
Publication date 2009-07-20
Year available 2009
Sub-type Article (original research)
DOI 10.1111/j.1440-1754.2009.01536.x
Volume 45
Issue 9
Start page 541
End page 546
Total pages 6
Editor David Isaacs
Spencer W Beasley
Catherine Skellern
Mike South
David Tudehope
Place of publication United Kingdom
Publisher Wiley-Blackwell Publishing
Collection year 2010
Language eng
Subject C1
920299 Health and Support Services not elsewhere classified
110305 Emergency Medicine
111403 Paediatrics
Abstract Aims: To establish current acute seizure management through a review of clinical practice guidelines (CPGs) and reported physician management in the 11 largest paediatric emergency departments in Australia (n= 9) and New Zealand (n= 2) within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, and to compare this with Advanced Paediatric Life Support (APLS) guidelines and existing evidence. Methods: (i) Review of CPGs for acute seizure management at PREDICT sites. (ii) A standardised anonymous survey of senior emergency doctors at PREDICT sites investigating management of status epilepticus (SE). Results: Ten sites used seven different seizure CPGs. One site had no seizure CPG. First line management was with benzodiazepines (10 sites). Second line and subsequent management included phenytoin (10), phenobarbitone (10), thiopentone (9), paraldehyde (6) and midazolam infusion (5). Of 83 available consultants, 78 (94%) responded. First line management of SE without intravenous (IV) access included diazepam per rectum (PR) (49%), and midazolam intramuscular (41%) and via the buccal route (9%). First line management of SE with IV access included midazolam IV (50%) and diazepam IV (44%). The second line agent was phenytoin (88%); third line agents were phenobarbitone (33%), thiopentone and intubation (32%), paraldehyde PR (22%) and midazolam infusion (6%). Fourth line agents were thiopentone and intubation (60%), phenobarbitone (16%), midazolam infusion (13%) and paraldehyde (9%). Conclusions: Initial seizure management by CPG recommendations and reported physician practice was broadly similar across PREDICT sites and consistent with APLS guidelines. Practice was variable for second/third line SE management. Areas of controversy would benefit from multi-centred trials.
Keyword clinical practice guidelines
emergency department
research network
seizure
status epilepticus
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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Citation counts: TR Web of Science Citation Count  Cited 10 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 13 times in Scopus Article | Citations
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Created: Mon, 12 Apr 2010, 20:51:27 EST by Melanie Thomas on behalf of Paediatrics & Child Health - RBWH