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Methodology for the Pediatric Dose Optimization for Seizures in Emergency Medical Services (PediDOSE) study
Manish I Shah1, Kathleen M Adelgais2, James M Chamberlain3
1Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, 94304, USA. mshah5@stanford.edu.
Trials
|December 13, 2025
Summary
Age-based midazolam dosing in emergency medical services (EMS) may improve pediatric seizure treatment. This study compares age-based to weight-based dosing to enhance seizure cessation and safety in children.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Trials
- Pharmacology
Background:
- Seizures are a common pediatric emergency requiring prompt treatment.
- Current emergency medical services (EMS) practices for pediatric seizures often lead to underdosing and delayed medication.
- Intranasal or intramuscular midazolam is recommended, but effectiveness is limited by dosing errors.
Purpose of the Study:
- To evaluate the effectiveness and safety of a new EMS protocol using age-based midazolam dosing for pediatric seizures.
- To compare the efficacy of age-based dosing against current weight-based dosing in achieving seizure cessation before emergency department arrival.
Main Methods:
- A large, stepped wedge trial conducted across 20 cities within the Pediatric Emergency Care Applied Research Network (PECARN).
- Implementation of EMS protocols with four age-based categories for midazolam dosing.
- Primary outcome: seizure cessation upon emergency department arrival. Secondary outcome: incidence of respiratory failure.
Main Results:
- Study is ongoing; results not yet available.
Conclusions:
- An age-based dosing protocol has the potential to be a safer and more effective alternative to current weight-based dosing for pediatric seizures.
- Successful implementation could lead to a paradigm shift in prehospital pediatric seizure management.
- The age-based dosing concept may be applicable to other pediatric prehospital medications.
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