Morbidity Associated with Deviation from Pediatric Status Epilepticus Guidelines

Area of Science:

• Pediatric Critical Care Medicine
• Neurology
• Emergency Medicine

Background:

• Pediatric status epilepticus (PSE) management guidelines vary between institutions.
• Standardized treatment protocols are essential for optimal patient care.
• Benzodiazepine dosing is a critical factor in PSE management.

Purpose of the Study:

• To analyze deviations from institutional PSE treatment guidelines.
• To determine the impact of benzodiazepine dosage on intubation rates in PSE.
• To evaluate the relationship between benzodiazepine administration and the need for mechanical ventilation.

Main Methods:

• Retrospective cohort study of 66 pediatric intensive care unit (PICU) admissions for PSE (April 2019-April 2022).
• Patients categorized by total benzodiazepine dose: low (≤0.05 mg/kg), recommended (0.05-0.2 mg/kg), and high (>0.2 mg/kg).
• Intubation rates compared across dosage groups, controlling for hospital type and patient age.

Main Results:

• 62% of patients received high-dose benzodiazepines (median 0.34 mg/kg).
• The high-dose group was 15.9 times more likely to require intubation compared to recommended-dose groups.
• Recommended-dose and low-dose groups had significantly lower intubation frequencies.

Conclusions:

• Deviation towards high-dose benzodiazepine administration in PSE is common.
• Higher benzodiazepine doses are strongly associated with increased intubation likelihood in pediatric patients.
• Adherence to recommended benzodiazepine dosing protocols may reduce the need for intubation in PSE.