Management of Status Epilepticus in Children before and after Implementation of a Treatment Algorithm
Anne-Sophie Bard1, Noémie Savard1, Isabelle Laverdière2
1, PharmD, MSc, is with the Faculty of Pharmacy, Université Laval, and the Pharmacy Department, CHU de Québec - Université Laval, Québec, Quebec.
Insights
Implementing a status epilepticus (SE) treatment algorithm in children showed limited improvements in care. Lorazepam dosing remained suboptimal, indicating a need for enhanced clinician training in pediatric SE management.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Status epilepticus (SE) in children requires prompt and effective pharmacological management to prevent severe outcomes.
- Current treatment guidelines emphasize rapid administration of antiseizure medications (ASMs).
Purpose of the Study:
- To evaluate the impact of a new drug treatment algorithm on the management of pediatric SE.
- To assess compliance with the algorithm after its implementation.
Main Methods:
- A retrospective chart review of 108 pediatric patients diagnosed with SE treated between January 2019 and April 2023.
- Comparison of SE management strategies and outcomes before and after the algorithm's implementation across five hospitals.
Main Results:
- First-line treatment predominantly involved benzodiazepines (BZDs) in both pre- and post-algorithm groups.
- Time to treatment and choice of ASM showed minimal changes; however, weight-based lorazepam dosing remained suboptimal for patients under 40 kg.
- Algorithm compliance for ASM choice was high (98%), but dose compliance was only 53%.
Conclusions:
- The implemented drug treatment algorithm had a limited effect on pediatric SE management practices.
- Suboptimal lorazepam dosing persists, highlighting the need for further education and training for clinicians.
- Refinement of the algorithm or additional training may be necessary to improve SE treatment outcomes in children.
Background:
Pharmacological management of status epilepticus (SE) in children must be rapid and optimal to limit morbidity and mortality.
Objectives:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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