title: Optimizing Care With a Standardized Management Protocol for Patients With Infantile Spasms.
abstract: The primary aim of this quality improvement initiative was to increase the number of patients receiving first-line therapy (adrenocorticotropic hormone, corticosteroids, vigabatrin) as the initial treatment for infantile spasms. We implemented a standardized management protocol for infantile spasms based on the best available data and expert consensus. To assess the impact of this intervention, we compared the 3-month remission rates between prestandardization (January 2009 to August 2012) and poststandardization (September 2012 to May 2014) cohorts. We found that the percentage of patients receiving first-line therapy as the initial treatment was 57% (31/54) in the prestandardization cohort and 100% (35/35) in the poststandardization cohort (P < .001). The rate of infantile spasms remission was higher poststandardization compared to prestandardization (78.8% vs 30.6%, P < .001). Management standardization led to all patients receiving first-line therapy as the initial treatment and was associated with a significantly improved rate of infantile spasms remission 3 months after diagnosis.
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, The Ohio State University, Nationwide Children's Hospital.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Fedak
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, The Ohio State University, Nationwide Children's Hospital.
authors.forename: Anup D
authors.initials: AD
authors.lastname: Patel
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, The Ohio State University, Nationwide Children's Hospital.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Heyer
authors.affiliation: Department of Quality Improvement Services, Nationwide Children's Hospital.
authors.forename: Eric G
authors.initials: EG
authors.lastname: Wood
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, The Ohio State University, Nationwide Children's Hospital John.Mytinger@nationwidechildrens.org.
authors.forename: John R
authors.initials: JR
authors.lastname: Mytinger
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D019468:Disease Management; D006801:Humans; D007223:Infant; D007902:Length of Stay; D017410:Practice Guidelines as Topic; D012074:Remission Induction; D012189:Retrospective Studies; D013036:Spasms, Infantile / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants
keywords: West syndrome; infantile spasms; quality improvement; standardization