Management of status epilepticus in infants and children prior to pediatric ICU admission: deviations from the current guidelines.
OBJECTIVE
Despite the availability of guidelines for the treatment of status epilepticus (SE), there may be variability in the initial stabilization, evaluation, and pharmacologic treatment of infants and children with SE. To improve the treatment of such patients, documentation of these problems is needed. The current study is a prospective observational evaluation of the care received by pediatric patients with SE before Pediatric Intensive Care Unit (PICU) admission.


METHODS
Following admission to the PICU, the care received was reviewed from the available records and/or direct conversations with the healthcare providers.


RESULTS
The study cohort included 100 consecutive patients with SE. Potential issues in care included lack of laboratory evaluation. The following laboratory parameters were not obtained during the initial evaluation: serum sodium (9% of patients), serum or ionized calcium (22%), and serum glucose (16%). When serum glucose was measured, results were not available for 20 minutes or more in 37% of the patients. Ninety-two patients were treated with anticonvulsant medication as they were having active seizure activity at the initial presentation. Primary drug therapy for SE did not include a benzodiazepine in 11% of the treated patients. When a benzodiazepine was administered, dosing was outside of suggested guidelines in 22.5% of patients. Respiratory compromise was more common in patients who received a benzodiazepine dose greater than suggested guidelines.


CONCLUSIONS
Education regarding the initial evaluation and treatment of SE should focus on the appropriate laboratory evaluation required, suggested drug therapy, and dosing guidelines.
Tobias
Joseph D
JD
Department of Anesthesiology, University of Missouri, Columbia, MO 65212, USA. Tobiasj@health.missouri.edu
Berkenbosch
John W
JW
D000293:Adolescent; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects; D000927:Anticonvulsants / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D013226:Status Epilepticus / Q000188:drug therapy*
D014151:Anti-Anxiety Agents; D000927:Anticonvulsants; D001569:Benzodiazepines