Status epilepticus in the prehospital setting: treatment gaps and their association with hospital course

Status epilepticus (SE) is a time-critical neurological emergency associated with significant morbidity and mortality, making timely recognition and treatment particularly crucial. We aimed to evaluate whether prehospital factors were associated with in-hospital outcomes in a Lithuanian cohort.

We conducted a two-center retrospective observational study of adult SE episodes transported by emergency medical services (EMS) to two tertiary hospitals in Lithuania between 2015 and 2024. Prehospital EMS documentation and hospital medical records were reviewed to retrieve initial vital parameters, EMS time intervals, treatment characteristics, and outcomes, including intensive care unit (ICU) admission, total hospital and ICU length of stay, discharge destination, and in-hospital mortality. Associations were evaluated using univariable analyses and adjusted multivariable logistic and linear regression models.

A total of 273 SE episodes were included (60.4% male, median age 62 years). Benzodiazepines (BZD) were administered in 72.5% of episodes, in 19.0% patients received guideline-consistent first-line treatment. Median time from EMS call to BZD initiation was 16 min (IQR=12-26), to start of transportation - 40 min (IQR=32-53). Longer time to first-line BZD treatment was linked to institutional rather than home discharge (aOR 1.038, 95% CI 1.011 to 1.066, p = 0.006). Prolonged time to transport initiation was independently associated with total hospital (B = 141.1, 95% CI 39.0 to 243.2, p = 0.007) and ICU length of stay (B = 91.7, 95% CI 33.4 to 150.1, p = 0.002).

Prehospital time intervals emerged as the main potentially modifiable factors associated with in-hospital outcomes in SE. Frequent BZD undertreatment and non-recommended route use highlight gaps in guideline adherence in routine prehospital care.