Clinical Audit of the Emergency Management of Convulsive Status Epilepticus in Children Subsequently Admitted to...

Objective The objective of this study was to evaluate the emergency pre-paediatric intensive care unit (PICU) management of children with convulsive status epilepticus subsequently admitted to PICU, to identify opportunities for improving early management. Methods Retrospective case note review of children admitted to one PICU over two years (2004-2005) with a diagnosis of status epilepticus. We compared the pre-PICU management with national guidelines. Results Thirty-six of 739 (5%) of all PICU admissions were for epileptic seizures. Of the 32 children beyond the neonatal period, 26 had notes available for audit. Prolonged febrile seizure was the most common aetiology (9/26; 34%). Of the 19 children transferred by ambulance, six (32%) received pre-hospital treatment. Only one of these six received an appropriate dose of rectal diazepam. None received midazolam pre-hospital. The mean time from seizure onset to time of first emergency drug dose in those without pre-hospital treatment was 81 (range 30-265) minutes. Pre-PICU, in the Emergency Department, the Advanced Paediatric Life Support guidelines for status epilepticus were strictly followed in 10/26 (38%) while 7/26 (27%) received more than two doses of benzodiazepines in total. Of the 36 benzodiazepine doses given, nine (25%) were inappropriately low. The sequence of drugs suggested in the national guideline was not followed in 9/26 (35%), and 21 (81%) were intubated and ventilated. Conclusion As delay in giving emergency drugs is avoidable, we recommend that paramedical staff give pre-hospital emergency drugs more readily, and in the recommended dose. The use of buccal or intramuscular midazolam by paramedics and ambulance crews would facilitate prompt pre-hospital treatment. We also recommend continuous education and training of hospital staff about the importance of generally following guidelines, especially on the doses of emergency drugs.