Management of Status Epilepticus in Children before and after Implementation of a Treatment Algorithm

Pharmacological management of status epilepticus (SE) in children must be rapid and optimal to limit morbidity and mortality.

The primary objective was to compare SE management in children before and after the implementation of a drug treatment algorithm. The secondary objective was to describe the compliance of SE management with the algorithm following its implementation.

This evaluative cross-sectional population study with retrospective chart review was performed in a 5-site teaching hospital, which included a tertiary pediatric hospital. Eligible patients were between 1 month and under 18 years of age, had a diagnosis of SE, and received antiseizure medication (ASM) between January 1, 2019, and April 1, 2023.

The study involved 108 patients, 60 treated before algorithm implementation and 48 treated after implementation. In both groups, most patients received a benzodiazepine (BZD) as first-line treatment (96% [52/54] and 100% [44/44], respectively). For second-line treatment, the proportion of patients receiving a BZD was greater before than after implementation (36% [10/28] and 26% [6/23], respectively). For first-line treatment, the mean lorazepam dose for patients weighing 40 kg or less was suboptimal (0.08 [standard deviation 0.03] mg/kg in both groups). Median time from hospital arrival to treatment was 7 minutes before and 6 minutes after implementation of the algorithm. For first-line treatment, the choice of ASM and the doses were compliant with the algorithm for 98% (43/44) and 53% (23/43) of patients, respectively.

Implementation of the drug treatment algorithm brought limited changes at the study hospital. More specifically, choice of ASM and time between seizure onset and administration of ASM were similar before and after implementation. Weight-based doses of lorazepam remained suboptimal. Additional training should be given to clinicians.