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 Riviello1, R C Tasker1, D Tchapyjnikov1, A A Topjian1, M S Wainwright1, A Wilfong1, K Williams1, T Loddenkemper2. 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. tobias.loddenkemper@childrens.harvard.edu.
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.
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.
Authors: Syndi Seinfeld; Shlomo Shinnar; Shumei Sun; Dale C Hesdorffer; Xiaoyan Deng; Ruth C Shinnar; Kathryn O'Hara; Douglas R Nordli; L Matthew Frank; William Gallentine; Solomon L Moshé; John M Pellock Journal: Epilepsia Date: 2014-02-06 Impact factor: 5.864
Authors: Stuart Lewena; Victoria Pennington; Jason Acworth; Susan Thornton; Peter Ngo; Shona McIntyre; David Krieser; Jocelyn Neutze; Deirdre Speldewinde Journal: Pediatr Emerg Care Date: 2009-02 Impact factor: 1.454
Authors: Theodore Sheehan; Marta Amengual-Gual; Alejandra Vasquez; Nicholas S Abend; Anne Anderson; Brian Appavu; Ravindra Arya; Cristina Barcia Aguilar; J Nicholas Brenton; Jessica L Carpenter; Kevin E Chapman; Justice Clark; Raquel Farias-Moeller; William D Gaillard; Marina Gaínza-Lein; Tracy A Glauser; Joshua L Goldstein; Howard P Goodkin; Réjean M Guerriero; Linda Huh; Michele Jackson; Kush Kapur; Robert Kahoud; Yi-Chen Lai; Tiffani L McDonough; Mohamad A Mikati; Lindsey A Morgan; Edward J Novotny; Adam P Ostendorf; Eric T Payne; Katrina Peariso; Juan Piantino; Latania Reece; James J Riviello; Tristan T Sands; Kumar Sannagowdara; Renee Shellhaas; Garnett Smith; Robert C Tasker; Dmitry Tchapyjnikov; Alexis A Topjian; Mark S Wainwright; Angus Wilfong; Korwyn Williams; Bo Zhang; Tobias Loddenkemper Journal: Epilepsia Date: 2021-08-21 Impact factor: 6.740
Authors: Elan L Guterman; Joseph K Sanford; John P Betjemann; Li Zhang; James F Burke; Daniel H Lowenstein; S Andrew Josephson; Karl A Sporer Journal: Neurology Date: 2020-09-17 Impact factor: 9.910
Authors: 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; 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 Journal: Neurology Date: 2020-07-01 Impact factor: 9.910
Authors: Marcelo Bedoya-Sommerkamp; Victor Hugo Chau-Rodríguez; Jesús Medina-Ranilla; Alejandro Escalaya-Advíncula; Ray Ticse-Aguirre; Walter De La Cruz-Ramírez; Jorge G Burneo Journal: J Epilepsy Res Date: 2021-06-30