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Anti-NMDAR Encephalitis Clinical Practice Guideline: Improving Time to Diagnosis, Treatment, and Hospital Length of
Kelsey M Barter1, Catherine Fuchs1, Thomas B Graham1
1Division of Pediatric and Developmental Neurology, Department of Neurology (KMB), Washington University School of Medicine in St. Louis, MO; Division of Child and Adolescent Psychiatry (CF), Departments of Psychiatry and Behavioral Sciences and Pediatrics; Division of Pediatric Rheumatology (TBG); Division of Pediatric Neurology (LMP); and Division of Pediatric Rheumatology (MV), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Insights
A clinical practice guideline improved diagnosis and treatment for pediatric autoimmune encephalitis. The guideline led to faster evaluations and treatment initiation for children with suspected anti-NMDAR encephalitis.
Area of Science:
- Pediatric Neurology
- Immunology
- Clinical Practice Guidelines
Background:
- Autoimmune encephalitis (AE), particularly anti-methyl-d-aspartate receptor (NMDAR) AE, is the most common form in children.
- Standardized evaluation and treatment protocols are crucial for optimal patient outcomes.
Purpose of the Study:
- To assess the impact of a newly implemented clinical practice guideline (CPG) on the diagnostic and treatment timelines for pediatric AE.
- To evaluate changes in hospital length of stay (LOS) following CPG adoption.
Main Methods:
- A retrospective study comparing two 4-year periods: before (period 1) and after (period 2) CPG implementation.
- Data collected included diagnostic testing rates, time to diagnosis (lumbar puncture), time to treatment, and hospital LOS for pediatric rheumatology consults for AE.
Main Results:
- More patients underwent diagnostic testing in period 2 compared to period 1 (80 vs 34).
- Significant reductions were observed in the average time to diagnostic evaluation (5.4 to 1.5 days, p=0.0082) and time to treatment (7.6 to 3.9 days, p=0.018).
- A trend towards reduced hospital LOS was noted (40.4 to 29.2 days, p=0.23).
Conclusions:
- Implementation of a CPG for suspected AE in children is associated with accelerated diagnostic evaluation and treatment initiation.
- The CPG increased the utilization of diagnostic testing for AE, without altering the overall number of confirmed diagnoses.
Background And Objectives:
A clinical practice guideline (CPG) was created to standardize evaluation and treatment for patients with suspected anti-methyl-d-aspartate receptor (NMDAR) autoimmune encephalitis (AE), the most common AE in children. The objective of this study was to evaluate the CPG effect on time to diagnosis, treatment, and hospital length of stay (LOS).
Methods:
Patients with an inpatient consult to pediatric rheumatology for AE during a 4-year period (period 2) after CPG implementation were identified. Data were extracted and compared with data over the preceding 4-year period (period 1).
Results:
During period 1, fewer patients underwent diagnostic testing than during period 2 (34 vs 80). Number of patients diagnosed with AE did not differ from period 1 to that from period 2 (NMDAR AE 9 vs 8; seronegative AE 4 vs 5). The average time to diagnostic evaluation with lumbar puncture decreased from 5.4 to 1.5 days (p = 0.0082), and time to treatment decreased from 7.6 to 3.9 days (p = 0.018). LOS showed a trend toward improvement (40.4-29.2 days (p = 0.23)).
Discussion:
Creation of a CPG for patients with suspected AE was associated with an improved time to diagnostic evaluation and treatment. With the CPG, more patients underwent AE testing, though total diagnoses remained the same.
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