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Prehospital benzodiazepine use and need for respiratory support in paediatric seizures

Christina K Pfeiffer1,2, Karen Smith3,4, Stephen Bernard4,5

  • 1Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Emergency Medicine Journal : EMJ
|January 26, 2022
PubMed

Insights

Paramedics frequently treat pediatric seizures. Increased benzodiazepine (BZD) doses administered prehospital correlate with a higher need for respiratory support in children. Alternative treatments should be explored.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Pharmacology
  • Prehospital Care

Background:

  • Paramedics frequently manage pediatric seizures, a common emergency presentation.
  • Evidence for second-line treatment of benzodiazepine (BZD)-refractory pediatric seizures with parenteral long-acting antiepileptic drugs is emerging.
  • The association between prehospital BZD use and the need for respiratory support requires further investigation.

Purpose of the Study:

  • To determine the association between prehospital benzodiazepine (BZD) administration and the requirement for respiratory support in pediatric seizure patients.
  • To analyze the impact of the number of BZD doses on the need for respiratory intervention.
  • To inform the development of alternative prehospital treatments for pediatric seizures.

Main Methods:

  • Retrospective observational study utilizing state-wide ambulance service data (Ambulance Victoria).
  • Analysis of children aged 0-17 years assessed for seizures by paramedics, including demographics, treatment, and airway management.
  • Calculation of adjusted odds ratios (AOR) for respiratory support based on the number of BZD doses administered.

Main Results:

  • Over one year, 5112 children with suspected seizures were attended by paramedics.
  • The overall need for respiratory support was low (3.2%), but increased significantly with BZD administration.
  • Patients receiving 2 or more BZD doses had a substantially higher AOR for requiring respiratory support (AOR 4.6 and 10.3, respectively) compared to those receiving one dose.

Conclusions:

  • Increasing doses of benzodiazepines administered prehospital are associated with a greater need for respiratory support in pediatric seizure patients.
  • The findings highlight the potential risks of BZD-related respiratory depression in this population.
  • Further research into alternative prehospital antiepileptic drugs is warranted to minimize respiratory complications.
Abstract

Keywords:
respiratory

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