Improving emergency management of status epilepticus: a randomized high-fidelity simulator-based trial

Evaluating how different status epilepticus (SE) guideline formats affect physicians' management of SE in high-fidelity simulation. The primary objective was adherence to guideline-recommended diagnostic and treatment interventions; the secondary was guideline memorability.

A randomized controlled trial was conducted, randomizing physicians from various specialties at the University Hospital Basel, a Swiss academic care center into three groups: (1) without guidelines (controls), (2) with access to NCS guidelines, (3) provided with a condensed single-page guideline incorporating symbols to facilitate information assimilation and evaluation. Each group performed an identical simulated SE scenario. Primary endpoints included vital sign checks, therapeutic interventions, and timing. Secondary endpoints assessed questionnaire-based aftermath self-evaluation and guideline memorability.

Among 124 participating physicians, 35% were controls, 34% provided with NCS guideline, and 31% with the condensed single-page guideline. Participants using the condensed guideline showed higher adherence to key interventions, with significantly improved rates of side positioning for airway protection (63% with condensed guideline vs. 25% in controls and 26% in the full guideline group; p<0.001) and second-line antiseizure drug administration (97% vs. 70% and 86%; p=0.003). No significant differences were observed in vital sign checks or other interventions. The condensed guideline was rated as more memorable compared to the original guidelines (p=0.001).

Condensed SE guidelines improved adherence to selected emergency interventions compared with both full NCS guidelines and no guideline support. Guideline usability may represent a modifiable target for improving time-critical neurological emergencies.

Clinicaltrials.gov ID NCT03883516 2019-03-12.