Prehospital seizure management in the paediatric patient: a multicentre emergency department study

Seizures are one of the main neurological reasons for admission to paediatric emergency departments (ED). The early, appropriate management of acute seizures is crucial to improving patient outcomes, with prehospital care playing a critical role in this matter.

We conducted a retrospective cross-sectional study of patients under 18 years of age admitted due to seizures to a metropolitan paediatric ED during a period of one year (June 2023-May 2024). Prehospital management and its association with clinical progression were analysed.

A total of 697 emergency episodes of seizures were identified: 328 epileptic seizures (47.1%), 290 febrile seizures (41.6%), 47 convulsive status epilepticus (SE) (6.7%), and 32 febrile SE (4.6%). Patients were referred to the ED by the emergency medical services (EMS) in 73.5% of episodes (n = 512). A first dose of an antiseizure medication (ASM) was administered in the prehospital setting in 29.4% of episodes (n = 205), using a benzodiazepine in 99.5% (n = 204). Prehospital ASM administration was more frequent in patients attended by the EMS (P < .001). Prehospital protocol compliance was verified in 71.7% of episodes (n = 114). Patients attended by EMS had a higher likelihood of prehospital seizure control and hospital discharge after the episode (P < .05).

Prehospital care was associated with higher prehospital seizure control and lower rates of hospitalisation. These findings emphasise the relevance of studying prehospital management, enabling the identification of opportunities for improvement, not only related to EMS procedures, but also to caregivers' knowledge about paediatric seizures.