. 2020 Sep 1;95(9):e1222-e1235.

doi: 10.1212/WNL.0000000000010174. Epub 2020 Jul 1.

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

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, Affiliations

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.

PMID: 32611646
PMCID: PMC7538224
DOI: 10.1212/WNL.0000000000010174

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

Iván Sánchez Fernández et al. Neurology. 2020.

. 2020 Sep 1;95(9):e1222-e1235.

doi: 10.1212/WNL.0000000000010174. Epub 2020 Jul 1.

Authors

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.

PMID: 32611646
PMCID: PMC7538224
DOI: 10.1212/WNL.0000000000010174

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.

PubMed Disclaimer

Figures

**Figure 1. Kaplan-Meier curves comparing the periods 2011 to 2014 and 2015 to 2019 on time to the administration of the first class of each medication (BZD, non-BZD ASM, and CI)**
Time scales are truncated for different medications (time to first benzodiazepine [BZD] truncated at 60 minutes, time to first non-BZD antiseizure medication [ASM] truncated at 120 minutes, and time to first continuous infusion [CI] truncated at 500 minutes). (A) Cumulative probability of having received the first BZD. Time axis is truncated at 60 minutes. (B) Cumulative probability of having received the first non-BZD ASM. Time axis is truncated at 120 minutes. (C) Cumulative probability of having received the first CI (among those patients who received a CI). Time axis is truncated at 500 minutes.

Figure 2. Kaplan-Meier curves comparing the periods 2011 to 2014 and 2015 to 2019 on time to the administration of the first class of each medication (BZD, non-BZD ASM, and CI) stratified by onset out of the hospital (left) or in the hospital (right)
Time scales are truncated for different medications (time to first benzodiazepine [BZD] truncated at 60 minutes, time to first non-BZD antiseizure medication [ASM] truncated at 120 minutes, and time to first continuous infusion [CI] truncated at 500 minutes). (A) Cumulative probability of having received the first BZD in patients with refractory convulsive status epilepticus (rSE) onset out of the hospital. Time axis is truncated at 60 minutes. (B) Cumulative probability of having received the first non-BZD ASM in patients with rSE onset out of the hospital. Time axis is truncated at 120 minutes. (C) Cumulative probability of having received the first CI (among those patients who received a CI) in patients with rSE onset out of the hospital. Time axis is truncated at 500 minutes. (D) Cumulative probability of having received the first BZD in patients with rSE onset in the hospital. Time axis is truncated at 60 minutes. (E) Cumulative probability of having received the first non-BZD ASM in patients with rSE onset in the hospital. Time axis is truncated at 120 minutes. (F) Cumulative probability of having received the first CI (among those patients who received a CI) in patients with rSE onset in the hospital. Time axis is truncated at 500 minutes.

See this image and copyright information in PMC

Comment in

Reader Response: Association of Guideline Publication and Delays to Treatment in Pediatric Status Epilepticus.
Albuja AC, Bensalem-Owen MK, Villamar MF. Albuja AC, et al. Neurology. 2021 Mar 9;96(10):502-503. doi: 10.1212/WNL.0000000000011561. Neurology. 2021. PMID: 33686007 No abstract available.
Author Response: Association of Guideline Publication and Delays to Treatment in Pediatric Status Epilepticus.
Amengual-Gual M, Barcia Aguilar C, Loddenkemper T. Amengual-Gual M, et al. Neurology. 2021 Mar 9;96(10):503. doi: 10.1212/WNL.0000000000011560. Neurology. 2021. PMID: 33686008 No abstract available.

References

1. Chin RF, Neville BG, Peckham C, et al. . Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet 2006;368:222–229. - PubMed
1. Coeytaux A, Jallon P, Galobardes B, Morabia A. Incidence of status epilepticus in French-speaking Switzerland (EPISTAR). Neurology 2000;55:693–697. - PubMed
1. Dham BS, Hunter K, Rincon F. The epidemiology of status epilepticus in the United States. Neurocrit Care 2014;20:476–483. - PubMed
1. Wu YW, Shek DW, Garcia PA, Zhao S, Johnston SC. Incidence and mortality of generalized convulsive status epilepticus in California. Neurology 2002;58:1070–1076. - PubMed
1. Sánchez Fernández I, Loddenkemper T. Estimating the cost of admissions related to convulsive status epilepticus in the United States of America. Seizure 2018;61:186–198. - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Figures

Comment in

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical