Association of guideline publication and delays to treatment in pediatric status epilepticus

Iván Sánchez Fernández; Nicholas S Abend; Marta Amengual-Gual; Anne Anderson; Ravindra Arya; Cristina Barcia Aguilar; James Nicholas Brenton; Jessica L Carpenter; Kevin E Chapman; Justice Clark; Raquel Farias-Moeller; William D Gaillard; Marina Gaínza-Lein; Tracy Glauser; Joshua Goldstein; Howard P Goodkin; Réjean M Guerriero; Yi-Chen Lai; Tiffani McDonough; Mohamad A Mikati; Lindsey A Morgan; Edward Novotny Jr; Eric Payne; Katrina Peariso; Juan Piantino; Adam Ostendorf; Tristan T Sands; Kumar Sannagowdara; Robert C Tasker; Dimtry Tchapyjnikov; Alexis A Topjian; Alejandra Vasquez; Mark S Wainwright; Angus Wilfong; Kowryn Williams; Tobias Loddenkemper; pSERG

doi:10.1212/WNL.0000000000010174

Association of guideline publication and delays to treatment in pediatric status epilepticus

Neurology. 2020 Sep 1;95(9):e1222-e1235. doi: 10.1212/WNL.0000000000010174. Epub 2020 Jul 1.

Authors

Iván Sánchez Fernández¹, Nicholas S Abend¹, Marta Amengual-Gual¹, Anne Anderson¹, Ravindra Arya¹, Cristina Barcia Aguilar¹, James Nicholas Brenton¹, Jessica L Carpenter¹, Kevin E Chapman¹, Justice Clark¹, Raquel Farias-Moeller¹, William D Gaillard¹, Marina Gaínza-Lein¹, Tracy Glauser¹, Joshua Goldstein¹, Howard P Goodkin¹, Réjean M Guerriero¹, Yi-Chen Lai¹, Tiffani McDonough¹, Mohamad A Mikati¹, Lindsey A Morgan¹, Edward Novotny Jr¹, Eric Payne¹, Katrina Peariso¹, Juan Piantino¹, Adam Ostendorf¹, Tristan T Sands¹, Kumar Sannagowdara¹, Robert C Tasker¹, Dimtry Tchapyjnikov¹, Alexis A Topjian¹, Alejandra Vasquez¹, Mark S Wainwright¹, Angus Wilfong¹, Kowryn Williams¹, Tobias Loddenkemper²; pSERG

Collaborators

pSERG:
Seema Bansal, Sarah Kelley, Carl Stafstrom, Eric Kossoff, Christa Habela, Dalila Lewis, Tony Stanfield, Claudine Sculier, Arnold Sansevere, Kush Kapur, Melissa Sacco, Abby Duncan, Jordan McCoy, Kathryn DaSilva-Chiodo, Robert Faist, Daniel Santel, Victor LaFay, Peggy Clark, Sarah Borror, Andrea Debs, Caitlin Clohessy, Amanda Weber, Asri Yuliati, Aimee Luat, Azara Singh, Ashley Helseth, David Turner, Cecilia Fernandes, Linh Tran, Melissa McLean, Anuranjita Nayak, James J. Riviello Jr., Kurt Hecox, Rupa Nallamothu, Rebecca Rehborg, David Goldstein, Erin Heinzen Cox, Colin Malone, Olivia Thornburg, Zachary Grinspan, Natasha Basma, Brian Appavu, Brian Burrows, Beata Dyar, Laura Mishler, Jacqueline Lee-Eng, Madison Streb, Cecil Hahn, Saptharishi (Rishi) Lalgudi Ganesan, Linda Huh, Nela Martic, Jantzen Fan, Osama Al-Jawadi, Conrado DeGuzman, Meghan Boersma, Steven Wainstein, Nathan Dean, Adrian Bumbut, Katherine Sperberg, Renee Shellhaas, Guilia Benedetti, Garnett Smith, Stephanie Rau, Shannon Lester-Pelham, Olga Selioutski, Inna Hughes, Lurie Seltzer

Affiliations

¹ From the Division of Epilepsy and Clinical Neurophysiology (I.S.F., M.A.-G., C.B.A., J.C., M.G.-L., A.V., T.L.), Department of Neurology, and Department of Neurology (R.C.T.), Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universitat de Barcelona, Spain; Division of Neurology (N.S.A.), Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania; Pediatric Neurology Unit (M.A.-G.), Department of Pediatrics, Hospital Universitari Son Espases, Universitat de les Illes Balears, Palma, Spain; Section of Pediatric Critical Care Medicine (A.A., Y.-C.L.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Division of Neurology (R.A., T.G., K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; University of Virginia Health (J.N.B., H.P.G.), Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatric Neurology (R.F.-M., K.S.), Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee; Instituto de Pediatría (M.G.-L.), Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile; Servicio de Neuropsiquiatría Infantil (M.G.-L.), Hospital Clínico San Borja Arriarán, Universidad de Chile, Santiago; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.G., T.M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric and Developmental Neurology (R.M.G.), Department of Neurology, Washington University School of Medicine, St. Louis, MO; Division of Pediatric Neurology (M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Department of Pediatrics and Neurology (L.A.M., E.N., M.S.W.), Seattle Children's Hospital, University of Washington; Center for Integrative Brain Research (L.A.M., E.N., M.S.W.), Seattle Children's Research Institute, WA; Department of Neurology (E.P.), Mayo Clinic, Mayo Clinic School of Medicine, Rochester, MN; Department of Neurology (J.P.), Doernbercher Children's Hospital, Oregon Health & Science University, Portland; Department of Neurology (A.O.), Nationwide Children's Hospital, Ohio State University, Columbus; Division of Child Neurology and Institute for Genomic Medicine (T.T.S.), Columbia University Irving Medical Center, New York Presbyterian Hospital, New York; Division of Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Division of Child and Adolescent Neurology (A.V.), Department of Neurology, Mayo Clinic, Rochester, MN; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix.
² From the Division of Epilepsy and Clinical Neurophysiology (I.S.F., M.A.-G., C.B.A., J.C., M.G.-L., A.V., T.L.), Department of Neurology, and Department of Neurology (R.C.T.), Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universitat de Barcelona, Spain; Division of Neurology (N.S.A.), Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania; Pediatric Neurology Unit (M.A.-G.), Department of Pediatrics, Hospital Universitari Son Espases, Universitat de les Illes Balears, Palma, Spain; Section of Pediatric Critical Care Medicine (A.A., Y.-C.L.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Division of Neurology (R.A., T.G., K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; University of Virginia Health (J.N.B., H.P.G.), Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatric Neurology (R.F.-M., K.S.), Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee; Instituto de Pediatría (M.G.-L.), Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile; Servicio de Neuropsiquiatría Infantil (M.G.-L.), Hospital Clínico San Borja Arriarán, Universidad de Chile, Santiago; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.G., T.M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric and Developmental Neurology (R.M.G.), Department of Neurology, Washington University School of Medicine, St. Louis, MO; Division of Pediatric Neurology (M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Department of Pediatrics and Neurology (L.A.M., E.N., M.S.W.), Seattle Children's Hospital, University of Washington; Center for Integrative Brain Research (L.A.M., E.N., M.S.W.), Seattle Children's Research Institute, WA; Department of Neurology (E.P.), Mayo Clinic, Mayo Clinic School of Medicine, Rochester, MN; Department of Neurology (J.P.), Doernbercher Children's Hospital, Oregon Health & Science University, Portland; Department of Neurology (A.O.), Nationwide Children's Hospital, Ohio State University, Columbus; Division of Child Neurology and Institute for Genomic Medicine (T.T.S.), Columbia University Irving Medical Center, New York Presbyterian Hospital, New York; Division of Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Division of Child and Adolescent Neurology (A.V.), Department of Neurology, Mayo Clinic, Rochester, MN; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix. tobias.loddenkemper@childrens.harvard.edu.

Abstract

Objective: To determine whether publication of evidence on delays in time to treatment shortens time to treatment in pediatric refractory convulsive status epilepticus (rSE), we compared time to treatment before (2011-2014) and after (2015-2019) publication of evidence of delays in treatment of rSE in the Pediatric Status Epilepticus Research Group (pSERG) as assessed by patient interviews and record review.

Methods: We performed a retrospective analysis of a prospectively collected dataset from June 2011 to September 2019 on pediatric patients (1 month-21 years of age) with rSE.

Results: We studied 328 patients (56% male) with median (25th-75th percentile [p₂₅-p₇₅]) age of 3.8 (1.3-9.4) years. There were no differences in the median (p₂₅-p₇₅) time to first benzodiazepine (BZD) (20 [5-52.5] vs 15 [5-38] minutes, p = 0.3919), time to first non-BZD antiseizure medication (68 [34.5-163.5] vs 65 [33-142] minutes, p = 0.7328), and time to first continuous infusion (186 [124.2-571] vs 160 [89.5-495] minutes, p = 0.2236). Among 157 patients with out-of-hospital onset whose time to hospital arrival was available, the proportion who received at least 1 BZD before hospital arrival increased after publication of evidence of delays (41 of 81 [50.6%] vs 57 of 76 [75%], p = 0.0018), and the odds ratio (OR) was also increased in multivariable logistic regression (OR 4.35 [95% confidence interval 1.96-10.3], p = 0.0005).

Conclusion: Publication of evidence on delays in time to treatment was not associated with improvements in time to treatment of rSE, although it was associated with an increase in the proportion of patients who received at least 1 BZD before hospital arrival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Anticonvulsants / therapeutic use*
Benzodiazepines / therapeutic use*
Cerebral Palsy / epidemiology
Child
Child, Preschool
Developmental Disabilities / epidemiology
Emergency Medical Services / statistics & numerical data*
Epilepsy / epidemiology
Evidence-Based Medicine
Female
Hospital Mortality
Hospitals, Pediatric
Humans
Infant
Infusions, Intravenous
Intellectual Disability / epidemiology
Intensive Care Units, Pediatric
Length of Stay
Male
Practice Guidelines as Topic*
Professional Practice Gaps / statistics & numerical data*
Retrospective Studies
Status Epilepticus / drug therapy*
Status Epilepticus / epidemiology
Time-to-Treatment / statistics & numerical data*
Young Adult

Substances

Anticonvulsants
Benzodiazepines