title: Seizure Treatment in Children Transported to Tertiary Care: Recommendation Adherence and Outcomes.
abstract: Convulsive seizures account for 15% of pediatric air transports. We evaluated seizure treatment received in community hospital emergency departments among transported patients for adherence to recommended management.
  
  
  
  This study was a retrospective cohort study of children transported for an acute seizure to a tertiary pediatric hospital from 2010 to 2013. Seizure treatment was evaluated for adherence to recommended management. The primary outcome was intubation.
  
  
  
  Among 126 events, 61% did not receive recommended acute treatment. The most common deviation from recommended care was administration of >2 benzodiazepine doses. Lack of adherence to recommended care was associated with a greater than twofold increased risk of intubation (relative risk 2.4; 95% confidence interval, 1.4-4.13) and 1.5-fold increased risk of admission to the ICU (relative risk 1.65; 95% confidence interval, 1.24-2.16). Duration of ventilation was commonly <24 hours (87%) for patients who did or did not receive recommended acute seizure care. Among events treated initially with a benzodiazepine, only 32% received a recommended weight-based dosage, and underdosing was most common.
  
  
  
  Adherence to evidence-based recommended acute seizure treatment during initial care of pediatric patients using medical air transportation was poor. Intubation was more common when patients did not receive recommended acute seizure care. Educational efforts with a sustained quality focus should be directed to increase adherence to appropriate pediatric seizure treatment of children in community emergency departments.
authors.affiliation: Divisions of Critical Care Medicine and hsiefkes@ucdavis.edu.|Division of Critical Care Medicine, Department of Pediatrics, University of California Davis, Sacramento, California; and.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Siefkes
authors.affiliation: Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
authors.forename: Maija
authors.initials: M
authors.lastname: Holsti
authors.affiliation: Pediatric Neurology, Granger Medical Clinic, Riverton, Utah.
authors.forename: Denise
authors.initials: D
authors.lastname: Morita
authors.affiliation: Divisions of Critical Care Medicine and.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Cook
authors.affiliation: Divisions of Critical Care Medicine and.
authors.forename: Susan
authors.initials: S
authors.lastname: Bratton
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004632:Emergency Medical Services; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000628:therapy*; D063128:Tertiary Health Care; D014187:Transportation of Patients
chemical_list: D000927:Anticonvulsants