Seizure Treatment in Children Transported to Tertiary Care: Recommendation Adherence and Outcomes

Area of Science:

• Pediatric Emergency Medicine
• Neurology
• Clinical Quality Improvement

Background:

• Convulsive seizures represent a significant reason for pediatric air transport, accounting for 15% of cases.
• Evaluating the quality of acute seizure management in emergency departments is essential for optimizing patient care.

Purpose of the Study:

• To assess adherence to recommended management protocols for acute seizure treatment in pediatric patients undergoing air transport.
• To determine the impact of adherence on patient outcomes, specifically intubation rates.

Main Methods:

• A retrospective cohort study analyzed data from children transported for acute seizures to a tertiary pediatric hospital between 2010 and 2013.
• Seizure treatment was retrospectively evaluated for adherence to established guidelines.
• The primary outcome measure was the need for intubation.

Main Results:

• 61% of seizure events did not receive recommended acute treatment, with over-administration of benzodiazepines being a common deviation.
• Non-adherence to recommended care significantly increased the risk of intubation (RR 2.4) and intensive care unit (ICU) admission (RR 1.65).
• Weight-based benzodiazepine dosing was suboptimal in 68% of cases, with underdosing being prevalent.

Conclusions:

• Adherence to evidence-based acute seizure treatment in community emergency departments for pediatric patients is suboptimal.
• Failure to provide recommended care is associated with higher rates of intubation.
• Targeted educational interventions and quality improvement initiatives are needed to enhance pediatric seizure management in emergency settings.