Hospital Emergency Treatment of Convulsive Status Epilepticus: Comparison of Pathways From Ten Pediatric Research Centers.
Por:
Vasquez A, Gaínza-Lein M, Sánchez Fernández B, Abend NS, Anderson A, Brenton JN, Carpenter JL, Chapman K, Clark J, Gaillard WD, Glauser T, Goldstein J, Goodkin HP, Lai YC, Loddenkemper T, McDonough TL, Mikati MA, Nayak A, Payne E, Riviello J, Tchapyjnikov D, Topjian AA, Wainwright MS, Tasker RC and Pediatric Status Epilepticus Research Group (pSERG)
Publicada:
1 sep 2018
Ahead of Print:
11 jul 2018
Resumen:
OBJECTIVE: We aimed to evaluate and compare the status epilepticus treatment pathways used by pediatric status epilepticus research group (pSERG) hospitals in the United States and the American Epilepsy Society (AES) status epilepticus guideline. METHODS: We undertook a descriptive analysis of recommended timing, dosing, and medication choices in 10 pSERG hospitals' status epilepticus treatment pathways. RESULTS: One pathway matched the timeline in the AES guideline; nine pathways described more rapid timings. All pathways matched the guideline's stabilization phase in timing and five suggested that first-line benzodiazepine (BZD) be administered within this period. For second-line therapy timing (initiation of a non-BZD antiepileptic drug within 20 to 40 minutes), one pathway matched the guideline; nine initiated the antiepileptic drug earlier (median 10 [range five to 15] minutes). Third-line therapy timings matched the AES guideline (40 minutes) in two pathways; eight suggested earlier timing (median 20 [range 15 to 30] minutes). The first-line BZD recommended in all hospitals was intravenous lorazepam; alternatives included intramuscular midazolam or rectal diazepam. In second-line therapy, nine pathways recommended fosphenytoin. For third-line therapy, eight pathways recommended additional boluses of second-line medications; most commonly phenobarbital. Two pathways suggested escalation to third-line medication; most commonly midazolam. We found variance in dosing for the following medications: midazolam as first-line therapy, fosphenytoin, and levetiracetam as second-line therapy, and phenobarbital as third-line therapy medications. CONCLUSIONS: The pSERG hospitals status epilepticus pathways are consistent with the AES status epilepticus guideline in regard to the choice of medications, but generally recommend more rapid escalation in therapy than the guideline.
Filiaciones:
Vasquez A:
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Maryland
Gaínza-Lein M:
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Maryland
Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
Sánchez Fernández B:
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Maryland
Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain
Abend NS:
Division of Neurology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Anderson A:
Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
Brenton JN:
Department of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, Virginia
Carpenter JL:
Center for Neuroscience, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
Chapman K:
Departments of Pediatrics and Neurology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
Clark J:
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Maryland
Gaillard WD:
Center for Neuroscience, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
Glauser T:
Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
Goldstein J:
Ruth D. Ken M. Davee Pediatric Neurocritical Care Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Goodkin HP:
Department of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, Virginia
Lai YC:
Section of Pediatric Critical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
Loddenkemper T:
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Maryland
McDonough TL:
Division of Child Neurology, Department of Neurology, Columbia University Medical Center, Columbia University, New York, New York
Mikati MA:
Division of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, North Carolina
Nayak A:
Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
Payne E:
Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, Minnesota
Riviello J:
Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
Tchapyjnikov D:
Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, Minnesota
Topjian AA:
Division of Critical Care Medicine, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Wainwright MS:
Ruth D. Ken M. Davee Pediatric Neurocritical Care Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Division of Child Neurology, Department of Neurology, Seattle Children's Hospital, Seattle, Washington
Tasker RC:
Departments of Neurology and Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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