Public support for and concerns regarding pediatric dose optimization for seizures in emergency medical services: An exception from informed consent (EFIC) trial

Caleb E Ward; Kathleen M Adelgais; Maija Holsti; Kammy K Jacobsen; Harold K Simon; Claudia R Morris; Victor M Gonzalez; Gonzalo Lerner; Kimia Ghaffari; John M VanBuren; E Brooke Lerner; Manish I Shah; Pediatric Emergency Care Applied Research Network (PECARN) PediDOSE Study Group

doi:10.1111/acem.14884

Public support for and concerns regarding pediatric dose optimization for seizures in emergency medical services: An exception from informed consent (EFIC) trial

Acad Emerg Med. 2024 Mar 7. doi: 10.1111/acem.14884. Online ahead of print.

Affiliations

¹ George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC, USA.
² University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA.
³ University of Utah, Primary Children's Medical Center, Salt Lake City, Utah, USA.
⁴ University of Utah, Salt Lake City, Utah, USA.
⁵ Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
⁶ Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
⁷ University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.

PMID: 38450918
DOI: 10.1111/acem.14884

Abstract

Background: Federal regulations allow exception from informed consent (EFIC) to study emergent conditions when obtaining prospective consent is not feasible. Little is known about public views on including children in EFIC studies. The Pediatric Dose Optimization for Seizures in EMS (PediDOSE) trial implements age-based, standardized midazolam dosing for pediatric seizures. The primary objective of this study was to determine public support for and concerns about the PediDOSE EFIC trial. The secondary objective was to assess how support for PediDOSE varied by demographics.

Methods: We conducted a mixed-methods study in 20 U.S. communities. Participants reviewed information about PediDOSE before completing an online survey. Descriptive data were generated. Univariable and multivariable logistic regression analysis identified factors associated with support for PediDOSE. Reviewers identified themes from free-text response data regarding participant concerns.

Results: Of 2450 respondents, 79% were parents/guardians, and 20% had a child with previous seizures. A total of 96% of respondents supported PediDOSE being conducted, and 70% approved of children being enrolled without prior consent. Non-Hispanic Black respondents were less likely than non-Hispanic White respondents to support PediDOSE with an adjusted odds ratio (aOR) of 0.57 (95% CI 0.42-0.75). Health care providers were more likely to support PediDOSE, with strongest support among prehospital emergency medicine clinicians (aOR 5.82, 95% CI 3.19-10.62). Age, gender, parental status, and level of education were not associated with support of PediDOSE. Common concerns about PediDOSE included adverse effects, legal and ethical concerns about enrolling without consent, and potential racial bias.

Conclusions: In communities where this study will occur, most respondents supported PediDOSE being conducted with EFIC and most approved of children being enrolled without prior consent. Support was lowest among non-Hispanic Black respondents and highest among health care providers. Further research is needed to determine optimal ways to address the concerns of specific racial and ethnic groups when conducting EFIC trials.

Keywords: emergency medical services, pediatrics; informed consent; research ethics; seizures.

Grants and funding

U01NS114042/NS/NINDS NIH HHS/United States