title: Targeted temperature management for acute encephalopathy in a Japanese secondary emergency medical care hospital.
abstract: BACKGROUND
  The goals of this study, conducted in our secondary emergency care hospital, were to assess the effectiveness of targeted temperature management (TTM) for acute encephalopathy secondary to status epilepticus and to consider appropriate adaptations for use of TTM in this setting.
  
  
  METHODS
  Medical records of patients admitted with acute encephalopathy to Hirakata City Hospital between January 2010 and December 2014 were retrospectively reviewed. Cases treated with TTM (36 °C) and methylprednisolone pulse (MP) therapy (TTM/MP) were compared with those treated with conventional MP regarding clinical courses and outcomes.
  
  
  RESULTS
  In total, 20 children were retrospectively enrolled. In the TTM/MP group (10 cases) all survived intact. In the MP group (10 cases), 4 cases were left with neurological sequelae. Furthermore, in the TTM/MP group, the body temperature dropped more quickly. For pediatricians in this secondary emergency hospital, implementing the body temperature management system was not difficult. There were no complications caused by hypothermia.
  
  
  CONCLUSIONS
  Use of TTM as the initial treatment for acute encephalopathy in the early-onset stage is possible in a secondary emergency care hospital. However, some acute encephalopathy cases are the so-called fulminant type; DIC or shock develops soon after onset and so it is sometimes difficult to introduce TTM. Fulminant-type patients should be transported to tertiary emergency care hospitals. Secondary emergency care hospitals must carefully select cases for TTM, keeping the possibility of transport to a tertiary emergency hospital in mind at all times.
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Murata
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan. Electronic address: dbs003@art.osaka-med.ac.jp.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kashiwagi
authors.affiliation: Department of Child Neurology, Tanabe Children's Clinic, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Tanabe
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Chizu
authors.initials: C
authors.lastname: Oba
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Shigehara
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamazaki
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Ashida
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sirasu
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Okasora
authors.affiliation: Department of Pediatrics, Osaka Medical College, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tamai
mesh_terms: D001831:Body Temperature / Q000502:physiology; D001927:Brain Diseases / Q000209:etiology / Q000628:therapy*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007223:Infant; D007564:Japan; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D008775:Methylprednisolone
keywords: Acute encephalopathy; Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD); Hypothermia; Normothermia; Secondary emergency medical care; Status epilepticus; Targeted temperature management