Prehospital intranasal midazolam for the treatment of pediatric seizures.
BACKGROUND
The local emergency medical services (EMS) council implemented a new pediatric treatment protocol using a Mucosal Atomization Device (MAD) to deliver intranasal (IN) midazolam for seizure activity.


METHODS
We sought to compare outcomes in seizing pediatric patients treated with IN midazolam using a MAD (IN-MAD midazolam) to those treated with rectal (PR) diazepam, 18 months before and after the implementation of the protocol.


RESULTS
Of 857 seizure patients brought by EMS to our emergency department (ED), 124 patients (14%) had seizure activity in the presence of EMS and were eligible for inclusion in this study. Of the 124 patients eligible for this study, 67 patients (54%) received no medications in the prehospital setting, 39 patients (32%) were treated with IN-MAD midazolam, and 18 patients (15%) were treated with PR diazepam. Median seizure time noted by EMS was 19 minutes longer for PR diazepam (30 minutes) when compared with IN-MAD midazolam (11 minutes, P = 0.003). Patients treated with PR diazepam in the prehospital setting were significantly more likely to have a seizure in the ED (odds ratio [OR], 8.4; confidence interval [CI], 1.6-43.7), ED intubation (OR, 12.2; CI, 2.0-75.4), seizure medications in the ED to treat ongoing seizure activity (OR, 12.1; CI, 2.2-67.8), admission to the hospital (OR, 29.3; CI, 3.0-288.6), and admission to the pediatric intensive care unit (OR, 53.5; CI, 2.7-1046.8).


CONCLUSIONS
The IN-MAD midazolam controlled seizures better than PR diazepam in the prehospital setting and resulted in fewer respiratory complications and fewer admissions.
Holsti
Maija
M
Division of Pediatric Emergency Medicine, Department of Pediatrics, Primary Children's Medical Center/University of Utah, Salt Lake City, UT 84158, USA. maija.holsti@hsc.utah.edu
Sill
Benjamin L
BL
Firth
Sean D
SD
Filloux
Francis M
FM
Joyce
Steven M
SM
Furnival
Ronald A
RA
D000281:Administration, Intranasal; D000285:Administration, Rectal; D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003975:Diazepam / Q000008:administration & dosage / Q000627:therapeutic use; D004341:Drug Evaluation; D004630:Emergencies; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006753:Hospital Records / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use*; D009330:Nebulizers and Vaporizers; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
D000927:Anticonvulsants; D006993:Hypnotics and Sedatives; D003975:Diazepam; D008874:Midazolam