The short-term outcome of seizure management by prehospital personnel: a comparison of two protocols.
OBJECTIVE
To evaluate the impact of an emergency medical service protocol with reduced diazepam dose on the intubation rate of children with seizure activity treated by emergency medical service personnel and to evaluate the short-term outcome comparing 2 emergency medical service treatment protocols.


METHODS
Retrospective review of the emergency medical service and hospital databases of children 0-18 years with seizure activity. Prior to January 1996, the county emergency medical service protocol recommended a diazepam dose of 0.2-0.5 mg/kg i.v. or pr for termination of seizure activity (group 1). As of January 1996, the diazepam dose was reduced to 0.05-0.1 mg/kg i.v. or pr (group 2). Demographics, emergency medical service and emergency department interventions, and disposition data were abstracted.


RESULTS
1516 subjects met the enrollment criteria: 1003 (66%) in group 1 and 513 (34%) in group 2. Emergency medical service administered diazepam to 288 subjects: 189 (19%) in group 1 and 99 (19%) in group 2. Twenty (7%) of all treated subjects required intubation: 19 in group 1 and 1 in group 2 (relative risk 9.7, 95% CI 1.30-72.5). Mean diazepam dose was 0.17 mg/kg in group 1 and 0.13 mg/kg in group 2 (mean difference 0.04, 95% CI 0.02-0.06). No significant difference in the requirement for repeated anticonvulsant dose, complications, or emergency department interventions was noted. However, hospital admission rate was lower in group 2 (rate difference 0.06, 95% CI 0.01-0.11).


CONCLUSIONS
Our study demonstrated a reduction in intubation rate and a need for hospitalization in the reduced diazepam dose emergency medical service protocol. The reduction in the diazepam dose was effective in terminating the seizure activity and did not increase the risk of adverse events.
Galustyan
Sergey G
SG
Emergency Medicine Section, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
Walsh-Kelly
Christine M
CM
Szewczuga
Del
D
Bergholte
Jo
J
Hennes
Halim
H
D000927:Anticonvulsants / Q000008:administration & dosage* / Q000627:therapeutic use; D019090:Case Management; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003975:Diazepam / Q000008:administration & dosage* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004630:Emergencies; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012640:Seizures / Q000628:therapy*; D016896:Treatment Outcome; D014922:Wisconsin / Q000453:epidemiology
D000927:Anticonvulsants; D003975:Diazepam