Factors associated with treatment delays in pediatric refractory convulsive status epilepticus

I Sánchez Fernández; M Gaínza-Lein; N S Abend; A E Anderson; R Arya; J N Brenton; J L Carpenter; K E Chapman; J Clark; W D Gaillard; T A Glauser; J L Goldstein; H P Goodkin; A R Helseth; M C Jackson; K Kapur; Y-C Lai; T L McDonough; M A Mikati; A Nayak; K Peariso; J J Riviello Jr; R C Tasker; D Tchapyjnikov; A A Topjian; M S Wainwright; A Wilfong; K Williams; T Loddenkemper; Pediatric Status Epilepticus Research Group (pSERG)

doi:10.1212/WNL.0000000000005488

Factors associated with treatment delays in pediatric refractory convulsive status epilepticus

Neurology. 2018 May 8;90(19):e1692-e1701. doi: 10.1212/WNL.0000000000005488. Epub 2018 Apr 11.

Authors

I Sánchez Fernández¹, M Gaínza-Lein¹, N S Abend¹, A E Anderson¹, R Arya¹, J N Brenton¹, J L Carpenter¹, K E Chapman¹, J Clark¹, W D Gaillard¹, T A Glauser¹, J L Goldstein¹, H P Goodkin¹, A R Helseth¹, M C Jackson¹, K Kapur¹, Y-C Lai¹, T L McDonough¹, M A Mikati¹, A Nayak¹, K Peariso¹, J J Riviello Jr¹, R C Tasker¹, D Tchapyjnikov¹, A A Topjian¹, M S Wainwright¹, A Wilfong¹, K Williams¹, T Loddenkemper²; Pediatric Status Epilepticus Research Group (pSERG)

Collaborators

Pediatric Status Epilepticus Research Group (pSERG):
Seema Bansal, Sarah Kelley, Carl Stafstrom, Eric Kossoff, Christa Habela, Dalila Lewis, Iván Sánchez Fernández, Marina Gaínza-Lein, Alejandra Vasquez, Marta Amengual-Gual, Michele Jackson, Justice Clark, Arnold Sansevere, Tobias Loddenkemper, Kush Kapur, J Nicholas Brenton, Howard P Goodkin, Mark Wainwright, Joshua Goldstein, Robert Faist, Katrina Peariso, Ravindra Arya, Tracy A Glauser, Adam Ostendorf, Kevin E Chapman, Amanda Weber, Asri Yuliati, Aimee Luat, Azara Singh, Dmrity Tchapyjnikov, Ashley Helseth, David Turner, Mohamad Mikati, Anne Anderson, Anuranjita Nayak, James J Riviello Jr, Kumar Sannagowdara, Kurt Hecox, Raquel Farias-Moeller, David Goldstein, Erin Heinzen Cox, Colin Malone, Tiffani L McDonough, Zachary Grinspan, Nicholas Abend, Alexis Topjian, Angus Wilfong, Korwyn Williams, Brian Appavu, Juan Piantino, Eric Payne, Lindsey Morgan, Edward Novotny, Rejéan Guerriero, Cecil Hahn, Linda Huh, Jessica Carpenter, Nathan Dean, William Gaillard

Affiliations

¹ From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, 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 Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix.
² From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, 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 Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix. [email protected].

Abstract

Objective: To identify factors associated with treatment delays in pediatric patients with convulsive refractory status epilepticus (rSE).

Methods: This prospective, observational study was performed from June 2011 to March 2017 on pediatric patients (1 month to 21 years of age) with rSE. We evaluated potential factors associated with increased treatment delays in a Cox proportional hazards model.

Results: We studied 219 patients (53% males) with a median (25th-75th percentiles [p₂₅-p₇₅]) age of 3.9 (1.2-9.5) years in whom rSE started out of hospital (141 [64.4%]) or in hospital (78 [35.6%]). The median (p₂₅-p₇₅) time from seizure onset to treatment was 16 (5-45) minutes to first benzodiazepine (BZD), 63 (33-146) minutes to first non-BZD antiepileptic drug (AED), and 170 (107-539) minutes to first continuous infusion. Factors associated with more delays to administration of the first BZD were intermittent rSE (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.14-2.09; p = 0.0467) and out-of-hospital rSE onset (HR 1.5, 95% CI 1.11-2.04; p = 0.0467). Factors associated with more delays to administration of the first non-BZD AED were intermittent rSE (HR 1.78, 95% CI 1.32-2.4; p = 0.001) and out-of-hospital rSE onset (HR 2.25, 95% CI 1.67-3.02; p < 0.0001). None of the studied factors were associated with a delayed administration of continuous infusion.

Conclusion: Intermittent rSE and out-of-hospital rSE onset are independently associated with longer delays to administration of the first BZD and the first non-BZD AED in pediatric rSE. These factors identify potential targets for intervention to reduce time to treatment.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Anticonvulsants / therapeutic use*
Benzodiazepines / therapeutic use*
Child
Child, Preschool
Drug Resistant Epilepsy / drug therapy*
Female
Hospitalization / statistics & numerical data
Humans
Infant
Infant, Newborn
Male
Prospective Studies
Retrospective Studies
Statistics, Nonparametric
Status Epilepticus / drug therapy*
Time-to-Treatment*
Treatment Outcome
Young Adult

Substances

Anticonvulsants
Benzodiazepines

Abstract

Publication types

MeSH terms

Substances

Grants and funding