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Journal of Pediatric Epilepsy 2024; 13(02): 017-023
DOI: 10.1055/s-0044-1779495
Original Article

Standardizing the Treatment for Pediatric Status Epilepticus: A Quality Improvement Study

Rishi Bhargava
1   Department of Emergency Medicine, Miller Children's and Women's Hospital of Long Beach, Long Beach, California, United States
,
Nicole Cobo
2   Department of Pediatric Neurology, Miller Children's and Women's Hospital of Long Beach, Long Beach, California, United States
,
Gabrielle Smith
1   Department of Emergency Medicine, Miller Children's and Women's Hospital of Long Beach, Long Beach, California, United States
,
Heather Hestekin
3   Department of Long Beach Memorial Pharmacy, Long Beach Memorial Medical Center, Long Beach, California, United States
,
Tricia Morphew
4   Morphew Consulting LLC, Bothell, Washington, United States
5   Memorialcare Health System, Fountain Valley, California, United States
,
Christopher Babbitt 
6   Department of Pediatric Critical Care, Miller Children's and Women's Hospital of Long Beach, Long Beach, California, United States
› Author Affiliations Funding We would like to acknowledge the Memorial Medical Foundation whose funding helped with the statistical analysis of the manuscript and expenses associated with Dr. Babbitt presenting an abstract at the Society of Critical Care Medicine Conference 2023. Virtual Pediatric Systems data were provided by VPS, LLC. No endorsement or editorial restriction of the interpretation of these data or opinions of the authors has been implied or stated.
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Abstract

Approximately 30 to 40% of children with generalized convulsive status epilepticus remain refractory to benzodiazepines. Due to inconsistences in our approach for these patients in the emergency department, we initiated a quality improvement project to standardize the treatment process.

A plan, do, study, act (PDSA) format was used for the project that involved creating a treatment algorithm based on the American Epilepsy Society (AES) guidelines, educating the staff on the treatment recommendations, and then collecting clinical data. We selected time to second-line anticonvulsant therapy as our primary outcome measure. Following the implementation of the treatment algorithm and order set, we performed comparative analyses of the pre- and post-implementation cohorts.

A total of 21 pre- and 36 post-implementation patients were identified. Baseline data demonstrated no difference in age or gender. Post-implementation patients received second-line therapy sooner (24 vs. 39 minutes, p = 0.001) and more post patients received second-line therapy within the AES guideline's time frame (83 vs. 52%, p = 0.012) compared with the pre-implementation patients. In a multivariable analysis, post-implementation patients had a higher likelihood of receiving second-line therapy within the AES-recommended time frame (odds ratio [OR] = 5.78; 95% confidence interval [CI]: 1.49–22.48; p = 0.011). Age, gender, intubation status, anticonvulsants given prior to emergency department (ED), and treatment by a pediatric ED specialist were not associated with increased odds of provider adherence to AES guidelines.

In conclusion, a standardized approach utilizing a treatment algorithm for patients with pediatric benzodiazepine refractory status epilepticus was associated with reduced time to administration of second-line anticonvulsant therapy and better compliance with AES guidelines in a mixed pediatric and adult ED setting.

Keywords

seizures - anticonvulsant - benzodiazepines


Publication History

Received: 09 June 2023

Accepted: 29 December 2023

Article published online:
28 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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