Pediatric residency guidelines for management of status epilepticus

We reviewed 21 protocols for the evaluation and treatment of status epilepticus currently in use in pediatric residency programs. Guidelines were compared to determine variations in the recommendations for initial patient assessment, choice of anticonvulsant therapy, and instructions for medication administration. There was wide variation in recommendations for patient stabilization procedures and laboratory measurements. Fifteen different sequences of anticonvulsant administration were listed. The initial drug of choice was intravenous diazepam in 81% of the programs, in doses ranging from 0.1 to 0.75 mg/kg. The preference for the second-line anticonvulsant was divided equally between phenytoin and phenobarbital. Phenytoin was not mentioned at all in three (14%) of the protocols, while paraldehyde was included in 14 (66%). Instructions for paraldehyde administration were confusing, imprecise, and occasionally inappropriate. We conclude that there is no well-accepted approach to the management of status epilepticus in pediatric patients. Furthermore, the guidelines in current use frequently are incomplete and probably confusing to residents.