title: Risk factors for apnea in pediatric patients transported by paramedics for out-of-hospital seizure.
abstract: OBJECTIVE
  Apnea is a known complication of pediatric seizures, but patient factors that predispose children are unclear. We seek to quantify the risk of apnea attributable to midazolam and identify additional risk factors for apnea in children transported by paramedics for out-of-hospital seizure.
  
  
  METHODS
  This is a 2-year retrospective study of pediatric patients transported by paramedics to 2 tertiary care centers. Patients were younger than 15 years and transported by paramedics to the pediatric emergency department (ED) for seizure. Patients with trauma and those with another pediatric ED diagnosis were excluded. Investigators abstracted charts for patient characteristics and predefined risk factors: developmental delay, treatment with antiepileptic medications, and seizure on pediatric ED arrival. Primary outcome was apnea defined as bag-mask ventilation or intubation for apnea by paramedics or by pediatric ED staff within 30 minutes of arrival.
  
  
  RESULTS
  There were 1,584 patients who met inclusion criteria, with a median age of 2.3 years (Interquartile range 1.4 to 5.2 years). Paramedics treated 214 patients (13%) with midazolam. Seventy-one patients had apnea (4.5%): 44 patients were treated with midazolam and 27 patients were not treated with midazolam. After simultaneous evaluation of midazolam administration, age, fever, developmental delay, antiepileptic medication use, and seizure on pediatric ED arrival, 2 independent risk factors for apnea were identified: persistent seizure on arrival (odds ratio [OR]=15; 95% confidence interval [CI] 8 to 27) and administration of field midazolam (OR=4; 95% CI 2 to 7).
  
  
  CONCLUSIONS
  We identified 2 risk factors for apnea in children transported for seizure: seizure on arrival to the pediatric ED and out-of-hospital administration of midazolam.
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: nichole.bosson@gmail.com.
authors.forename: Nichole
authors.initials: N
authors.lastname: Bosson
authors.affiliation: Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Los Angeles, CA.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Santillanes
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kaji
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fang
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Tasha
authors.initials: T
authors.lastname: Fernando
authors.affiliation: Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Los Angeles, CA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Huang
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA; School of Nursing, University of California, Los Angeles, CA.
authors.forename: Jumie
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, and the Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Gausche-Hill
mesh_terms: D058109:Airway Management / Q000009:adverse effects / Q000706:statistics & numerical data; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D001049:Apnea / Q000139:chemically induced / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000150:complications*
chemical_list: D000927:Anticonvulsants; D008874:Midazolam