Management of status epilepticus in children prior to medical retrieval: Deviations from the guidelines

Area of Science:

• Pediatric Emergency Medicine
• Neurology
• Clinical Practice Guidelines

Background:

• Status epilepticus (SE) is a medical emergency in children requiring prompt and guideline-adherent treatment.
• Adherence to established clinical practice guidelines for SE management can significantly impact patient outcomes.
• The Newborn and Paediatric Emergency Transport Service (NETS) in New South Wales provides critical care for pediatric emergencies.

Purpose of the Study:

• To assess the impact of adherence to treatment guidelines on outcomes for children with status epilepticus.
• To evaluate management variations from the New South Wales clinical practice guideline for SE.
• To identify areas for improvement in SE treatment protocols within a prospective registry.

Main Methods:

• A retrospective review of children with SE treated and transported by NETS over one year.
• Analysis of treatment variations compared to the New South Wales clinical practice guideline for SE.
• Evaluation of medication administration timing and dosage, particularly benzodiazepines (BZD).

Main Results:

• Excessive administration of benzodiazepines (BZD) was noted in pediatric SE cases.
• A significant delay in administering appropriate second-line treatment for SE (median 45 minutes) was observed.
• Receiving five or more doses of BZD was associated with significantly higher odds of requiring intubation.

Conclusions:

• There is substantial room for improvement in clinician compliance with SE clinical practice guidelines.
• Current management practices for pediatric SE deviate from established guidelines, potentially affecting patient outcomes.
• Optimizing adherence to SE guidelines is crucial for reducing complications such as intubation.