Related Experiment Video
Updated: Nov 25, 2025
Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy
Published on: April 11, 2019
Automated identification and quality measurement for pediatric convulsive status epilepticus
David L Hess-Homeier1, Karishma Parikh2,3, Natasha Basma4
1Weill Cornell Medical College, New York, NY, USA.
Insights
Delays in treating refractory convulsive status epilepticus (RCSE) impact patient outcomes. This study developed automated methods to track RCSE treatment times, aiming to improve adherence to quality measures for better pediatric care.
Area of Science:
- Neurology
- Pediatric Emergency Medicine
- Health Informatics
Background:
- Treatment delays for refractory convulsive status epilepticus (RCSE) are linked to poorer patient outcomes.
- Current pediatric RCSE treatment in the US often falls short of recommended guidelines.
- The American Academy of Neurology and Child Neurology Society (AAN/CNS) established a quality measure for RCSE treatment timeliness.
Purpose of the Study:
- To develop computable phenotypes for convulsive status epilepticus (CSE) and RCSE.
- To automate the calculation of the AAN/CNS RCSE quality measure.
- To assess adherence to the recommended 60-minute timeframe for third-line treatment in RCSE.
Main Methods:
- An observational cohort of pediatric patients presenting with seizures or epilepsy was analyzed.
- Computable phenotypes were developed using International Classification of Diseases (ICD) codes and treatment agent administration.
- Multivariate analyses were employed to construct and evaluate statistical models for identifying CSE, benzodiazepine-resistant status epilepticus (BRSE), and RCSE.
Main Results:
- The developed phenotypes accurately identified CSE (84% sensitivity, 81% PPV), BRSE (67% sensitivity, 89% PPV), and RCSE (94% sensitivity, 85% PPV).
- Median treatment times were 13 minutes for first-line (CSE), 24 minutes for second-line (BRSE), and 52 minutes for third-line (RCSE).
- Only 60% of RCSE patients received third-line treatment within the guideline's 60-minute target.
Conclusions:
- Automated identification of RCSE and its precursors is feasible with high accuracy.
- This automated approach enables efficient calculation of treatment times and quality measure adherence.
- The findings support quality improvement initiatives to enhance care for pediatric RCSE patients.
Objective:
Treatment delays for refractory convulsive status epilepticus (RCSE) are associated with worse outcomes. In the United States, treatment for pediatric RCSE is slower than guidelines recommend. To address this gap, the American Academy of Neurology and Child Neurology Society (AAN/CNS) developed a quality measure: the percentage of RCSE patients that receive third-line treatment within 60 minutes. We aimed to develop computable phenotypes for convulsive status epilepticus (CSE) and RCSE to automate calculation of the quality measure.
Methods:
From an observational cohort of children presenting to the emergency department for seizures or epilepsy, we identified presentations of RCSE and its precursors: CSE and benzodiazepine-resistant status epilepticus (BRSE). These served as a gold standard for computable phenotype development. Using multivariate analyses, we constructed and evaluated statistical models for case identification. We then evaluated adherence to the AAN/CNS RCSE quality measure.
Results:
From 664 charts, we identified 56 patients with CSE, 36 with BRSE, and 18 with RCSE. Four predictors were used: International Classification of Diseases (ICD) codes, and receiving first-, second-, or third-line agents shortly after presentation to the emergency department (ED). Combinations of these predictors identified CSE with 84% sensitivity and 81% positive predictive value (PPV), BRSE with 67% sensitivity and 89% PPV, and RCSE with 94% sensitivity and 85% PPV. Median (interquartile range [IQR]) time to treatment for first-line agent was 13 (5-27) minutes for CSE, second-line for BRSE was 24 (9.5-43.5) minutes, and third-line for RCSE was 52 (27-87) minutes. Sixty percent of RCSE patients received a third-line agent within 60 minutes of ED arrival.
Significance:
RCSE and its precursors can be identified automatically with high fidelity allowing automated calculation of time to treatment and the RCSE quality measure. This has the potential to facilitate quality improvement work and improve care for RCSE.
More Related Videos
10:22Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
Published on: December 6, 2016
10:25Multi-system Monitoring for Identification of Seizures, Arrhythmias and Apnea in Conscious Restrained Rabbits
Published on: March 27, 2021
Related Concept Videos
01:13Seizures: Classification
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...