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Investigating Associations Between Nonadherence to Guideline-Recommended Treatment of Pediatric Seizures and Adverse
Meaghan Moreau1, Helen Coo2, Niveditha Pattathil2
1Department of Pediatrics, Queen's University, Kingston, Ontario; Kingston Health Sciences Centre, Kingston, Ontario.
Insights
Pediatric seizure treatment guidelines are often not followed, with significant nonadherence noted. Electronic health records lack crucial data, hindering outcome analysis and necessitating prospective studies for accurate research on pediatric seizure management.
Area of Science:
- Pediatric Neurology
- Clinical Practice Guidelines
- Healthcare Research
Background:
- Nonadherence to established treatment guidelines for seizures may impact patient outcomes.
- Investigated the feasibility of a larger study on pediatric seizure treatment adherence.
Purpose of the Study:
- Assess adherence to pediatric seizure treatment guidelines.
- Evaluate the feasibility of studying treatment adherence and patient outcomes.
- Identify data gaps in medical records for seizure research.
Main Methods:
- Retrospective chart review of pediatric patients (≤18 years) with seizures.
- Two Ontario hospitals, 2019-2021.
- Grouped patients by seizure duration (<5 min vs. ≥5 min).
- Examined adherence, adverse outcomes, and data completeness.
Main Results:
- 44% of 78 pediatric patients did not receive guideline-recommended treatment.
- Common deviations: early antiseizure medication (ASM) use, delayed second ASM dose, inappropriate third-dose medication.
- High hospitalization rates (~90%); respiratory complications were rare.
- Significant data missing: seizure onset time (51%), emergency contact time (100%).
Conclusions:
- Substantial nonadherence to pediatric seizure treatment guidelines was observed.
- Medical records lack sufficient data for comprehensive outcome analysis.
- A multicenter prospective study is recommended to link nonadherence with patient outcomes.
Background:
Emerging evidence suggests that nonadherence to treatment guidelines for seizures may affect patient outcomes. We examined the feasibility of conducting a larger investigation to test this hypothesis in the pediatric population.
Methods:
We retrospectively reviewed charts of patients aged ≤18 years who presented with seizure to the emergency departments of two Ontario hospitals in 2019 to 2021. Patients were grouped by seizure duration (<5 minutes [n = 37], ≥5 minutes [n = 41]). We examined nonadherence to guideline-recommended treatment, adverse outcomes (hospitalization, length of stay, respiratory complications), and missing values for key variables.
Results:
Of 78 patients, 34 (44%) did not receive guideline-recommended treatment. Nonadherence was similar in the two groups (<5 minutes: 46%; ≥5 minutes: 41%). Common deviations included administering an antiseizure medication (ASM) for seizures of less than five minutes (46%), a delay (>10 minutes) between the first and second ASM doses (50%), and use of a benzodiazepine for the third dose (45%). Hospitalizations were common in both seizure duration groups (∼90%), whereas respiratory complications were relatively rare. Time of seizure onset was missing in 51% of charts, and none contained the time of first contact with emergency services when patients were transported by ambulance.
Conclusion:
We found evidence of substantial nonadherence to guideline-recommended treatment of pediatric seizures. Medical records do not contain sufficient information to comprehensively investigate this issue. A multicenter prospective study is the most feasible option to examine the association between nonadherence to guideline-recommended treatment and patient outcomes.
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