Preena Uppal1, Michael Cardamone2, John A Lawson2. 1. Sydney Children's Hospital, Department of Pediatric Neurology, High Street, Randwick, NSW, 2031, Australia; University of New South Wales - Randwick Campus, School of Women's and Children's Health, High Street, Randwick, NSW, 2052, Australia. Electronic address: preena.uppal@health.nsw.gov.au. 2. Sydney Children's Hospital, Department of Pediatric Neurology, High Street, Randwick, NSW, 2031, Australia; University of New South Wales - Randwick Campus, School of Women's and Children's Health, High Street, Randwick, NSW, 2052, Australia.
Abstract
OBJECTIVE: Due to a gap between published clinical guidelines on status epilepticus SE and clinician management of SE, a systematic review was performed to investigate treatment adherence to SE guidelines and its impact on patient outcomes. METHODS: Medline and Embase searches were conducted for studies appraising adherence to SE guidelines (from 1970 and 1st April 2018). The quality of eligible studies was assessed by QUADAS- 2 criteria. Comparison was made between patients where guidelines were followed and not followed. Various patient outcomes including intubation, ICU admission, morbidity and mortality were compared. A Forest plot was used to investigate the effect of adherence on outcome. RESULTS: A total of 3424 titles and abstracts were screened from the initial search after removal of duplicates. A total of 441 full text articles were reviewed in detail, and 22 articles were included in this study. The proportion of deviations ranged from 10.7% to 66.1%. Four studies were descriptive. Eighteen studies looked at the adverse effects of non-adherence. Eight studies showed respiratory depression and intubation were associated with excessive benzodiazepine use. A subset analysis showed 5.79 times higher odds of respiratory depression and intubation], if excessive benzodiazepines were given. The next most common variations were delayed management and insufficient treatment. These variations from the guidelines were associated with prolonged seizures. CONCLUSIONS: This review provides preliminary evidence that non-adherence to SE guidelines negatively impacts on patient outcomes. Appropriate and timely treatment is imperative for rapid seizure termination and improving outcomes.
OBJECTIVE: Due to a gap between published clinical guidelines on status epilepticus SE and clinician management of SE, a systematic review was performed to investigate treatment adherence to SE guidelines and its impact on patient outcomes. METHODS: Medline and Embase searches were conducted for studies appraising adherence to SE guidelines (from 1970 and 1st April 2018). The quality of eligible studies was assessed by QUADAS- 2 criteria. Comparison was made between patients where guidelines were followed and not followed. Various patient outcomes including intubation, ICU admission, morbidity and mortality were compared. A Forest plot was used to investigate the effect of adherence on outcome. RESULTS: A total of 3424 titles and abstracts were screened from the initial search after removal of duplicates. A total of 441 full text articles were reviewed in detail, and 22 articles were included in this study. The proportion of deviations ranged from 10.7% to 66.1%. Four studies were descriptive. Eighteen studies looked at the adverse effects of non-adherence. Eight studies showed respiratory depression and intubation were associated with excessive benzodiazepine use. A subset analysis showed 5.79 times higher odds of respiratory depression and intubation], if excessive benzodiazepines were given. The next most common variations were delayed management and insufficient treatment. These variations from the guidelines were associated with prolonged seizures. CONCLUSIONS: This review provides preliminary evidence that non-adherence to SE guidelines negatively impacts on patient outcomes. Appropriate and timely treatment is imperative for rapid seizure termination and improving outcomes.
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: Abhishek G Sathe; Ellen Underwood; Lisa D Coles; Jordan J Elm; Robert Silbergleit; James M Chamberlain; Jaideep Kapur; Hannah R Cock; Nathan B Fountain; Shlomo Shinnar; Daniel H Lowenstein; Eric S Rosenthal; Robin A Conwit; Thomas P Bleck; James C Cloyd Journal: Epilepsia Date: 2021-02-10 Impact factor: 5.864