title: The prehospital treatment of status epilepticus (PHTSE) study: design and methodology.
abstract: Status epilepticus is a neurological emergency that is typically first encountered and managed in the prehospital environment. Although aggressive pharmacological treatment of status epilepticus is well established in the emergency department and hospital settings, the relative risks and benefits of active therapy for status epilepticus in the prehospital setting are not known. The Prehospital Treatment of Status Epilepticus (PHTSE) study is a prospective, randomized, double-blind, placebo-controlled study designed to address the following aims: (1) to determine whether administration of benzodiazepines by paramedics is an effective and safe means of treating status epilepticus in the prehospital setting and whether this therapy influences longer-term patient outcome, (2) to determine whether lorazepam is superior to diazepam for the treatment of status epilepticus in the prehospital setting, and (3) to determine whether control of status epilepticus prior to arrival to the emergency department influences patient disposition. The initial phase of the PHTSE study began in January 1994 and was completed in February 1999 after the successful enrollment of 205 patients into the three treatment arms. In this paper, we describe the rationale for the conceptualization of the study and details of the study design and methodology, and emphasize some aspects of study implementation that are unique to research involving the emergency medical system.
authors.affiliation: Department of Neurology, University of California, San Francisco, CA, USA. daniel_lowenstein@hms.harvard.edu
authors.forename: D H
authors.initials: DH
authors.lastname: Lowenstein
authors.forename: B K
authors.initials: BK
authors.lastname: Alldredge
authors.forename: F
authors.initials: F
authors.lastname: Allen
authors.forename: J
authors.initials: J
authors.lastname: Neuhaus
authors.forename: M
authors.initials: M
authors.lastname: Corry
authors.forename: M
authors.initials: M
authors.lastname: Gottwald
authors.forename: N
authors.initials: N
authors.lastname: O'Neil
authors.forename: S
authors.initials: S
authors.lastname: Ulrich
authors.forename: S M
authors.initials: SM
authors.lastname: Isaacs
authors.forename: A
authors.initials: A
authors.lastname: Gelb
mesh_terms: D000328:Adult; D000465:Algorithms; D001569:Benzodiazepines / Q000627:therapeutic use*; D004311:Double-Blind Method; D004632:Emergency Medical Services; D006801:Humans; D016015:Logistic Models; D018401:Sample Size; D012495:San Francisco; D013226:Status Epilepticus / Q000188:drug therapy*
chemical_list: D001569:Benzodiazepines