title: Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of a simple linear midazolam-based protocol for the management of impending status epilepticus in children up to 18 years of age.
  
  
  METHODS
  This is a descriptive, quality assessment, retrospective chart review of children presenting with the chief complaint of seizure disorder in the emergency department (ED) of a tertiary care pediatric hospital and a triage category of resuscitation or urgent from April 1, 2009, to August 31, 2011. In children with at least one seizure episode in the ED treated according to the linear protocol, three main outcomes were assessed: compliance, effectiveness, and complications.
  
  
  RESULTS
  Of the 128 children meeting the above study criteria, 68 had at least one seizure episode in the ED, and treatment was required to terminate at least one seizure episode in 46 of 68 patients (67.6%). Fifty-five seizure episodes were treated in the 46 patients: 51 of 55 seizure episodes were treated with midazolam (92.7%) and 4 of 55 with lorazepam or diazepam (7.3%). Of those treated with midazolam, 86.3% (44 of 51) were successfully treated with one or two doses of midazolam. The median seizure duration for all treated patients was 6 minutes. Of the 42 patients treated with midazolam, 7 required either continuous positive airway pressure or intubation, and two patients were treated for hypotension. One patient died of pneumococcal meningitis.
  
  
  CONCLUSIONS
  This simple linear protocol is an effective and safe regimen for the treatment of impending status epilepticus in children.
authors: Geneviève
authors: G
authors: Tourigny-Ruel
authors: Dubravka
authors: D
authors: Diksic
authors: Elise
authors: E
authors: Mok
authors: David
authors: D
authors: McGillivray
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003975:Diazepam / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008874:Midazolam / Q000627:therapeutic use*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000927:Anticonvulsants; D006993:Hypnotics and Sedatives; D003975:Diazepam; D008874:Midazolam