Raoul Sutter1, Kai Tisljar2, Petra Opić2, Gian Marco De Marchis2, Stefano Bassetti2, Roland Bingisser2, Sabina Hunziker2, Stephan Marsch2. 1. From the Clinic for Intensive Care Medicine (R.S., K.T., P.O., S.M.), University Hospital Basel; Department of Neurology (R.S., G.M.D.M.), University Hospital Basel; Medical Faculty (R.S., G.M.D.M., S.B., R.B., S.H., S.M.), University of Basel; Division of Internal Medicine (P.O., S.B.), University Hospital Basel; Department of Emergency Medicine (R.B.), University Hospital Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland. Raoul.Sutter@usb.ch. 2. From the Clinic for Intensive Care Medicine (R.S., K.T., P.O., S.M.), University Hospital Basel; Department of Neurology (R.S., G.M.D.M.), University Hospital Basel; Medical Faculty (R.S., G.M.D.M., S.B., R.B., S.H., S.M.), University of Basel; Division of Internal Medicine (P.O., S.B.), University Hospital Basel; Department of Emergency Medicine (R.B.), University Hospital Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland.
Abstract
OBJECTIVES: To quantify the quality of physicians' emergency first response to status epilepticus (SE) and to identify risk factors for nonadherence to treatment guidelines in a standardized simulated scenario. METHODS: In this prospective trial, 58 physicians (of different background) of the University Hospital Basel, a Swiss academic medical care center, were confronted with a simulated SE. Primary outcomes were time to (1) airway protection, (2) supplementary oxygen, and (3) administration of antiseizure drugs (ASDs). RESULTS: All physicians recognized ongoing seizures. Airways were checked by 54% and protected by 16% within a median of 3.9 minutes. Supplementary oxygen was administered by 76% with a median of 2.8 minutes. First-line ASDs were administered by 98% (benzodiazepines 97% within a median of 2.9 minutes), and second-line ASDs by 57% within 8.1 minutes. Regarding secondary outcomes, the median time to monitor blood pressure and heart rate was 1.8 (interquartile range [IQR] 1.3-2.6) and 2.0 (IQR 1.4-2.7) minutes, respectively. Neurologic affiliation of physicians was associated with inadequate assessments of vital signs (odds ratio [OR] = 0.2; 95% CI 0.04-0.93) and most frequent administration of second-line ASDs (OR = 5.0; 95% CI 1.01-25.3). Knowing treatment guidelines and subjective certainty regarding SE diagnosis were associated with frequent administration of second-line ASDs (OR = 10.4; 95% CI 1.2-88.1). CONCLUSIONS: Nonadherence to SE treatment guidelines is frequent. The lack of airway assessment and protection in the simulated clinical scenario of SE may increase mortality and promote treatment refractoriness related to aspiration pneumonia. Guideline-based clinical training is urgently needed to increase the quality of SE management. REGISTRATION: ISRCTN registry (ID ISRCTN60369617; www.isrctn.com/ISRCTN60369617).
OBJECTIVES: To quantify the quality of physicians' emergency first response to status epilepticus (SE) and to identify risk factors for nonadherence to treatment guidelines in a standardized simulated scenario. METHODS: In this prospective trial, 58 physicians (of different background) of the University Hospital Basel, a Swiss academic medical care center, were confronted with a simulated SE. Primary outcomes were time to (1) airway protection, (2) supplementary oxygen, and (3) administration of antiseizure drugs (ASDs). RESULTS: All physicians recognized ongoing seizures. Airways were checked by 54% and protected by 16% within a median of 3.9 minutes. Supplementary oxygen was administered by 76% with a median of 2.8 minutes. First-line ASDs were administered by 98% (benzodiazepines 97% within a median of 2.9 minutes), and second-line ASDs by 57% within 8.1 minutes. Regarding secondary outcomes, the median time to monitor blood pressure and heart rate was 1.8 (interquartile range [IQR] 1.3-2.6) and 2.0 (IQR 1.4-2.7) minutes, respectively. Neurologic affiliation of physicians was associated with inadequate assessments of vital signs (odds ratio [OR] = 0.2; 95% CI 0.04-0.93) and most frequent administration of second-line ASDs (OR = 5.0; 95% CI 1.01-25.3). Knowing treatment guidelines and subjective certainty regarding SE diagnosis were associated with frequent administration of second-line ASDs (OR = 10.4; 95% CI 1.2-88.1). CONCLUSIONS: Nonadherence to SE treatment guidelines is frequent. The lack of airway assessment and protection in the simulated clinical scenario of SE may increase mortality and promote treatment refractoriness related to aspiration pneumonia. Guideline-based clinical training is urgently needed to increase the quality of SE management. REGISTRATION: ISRCTN registry (ID ISRCTN60369617; www.isrctn.com/ISRCTN60369617).
Authors: Jessica R Fesler; Anne E Belcher; Ahsan N Moosa; MaryAnn Mays; Lara E Jehi; Elia M Pestana Knight; Deepak K Lachhwani; Andreas V Alexopoulos; Dileep R Nair; Vineet Punia Journal: Neurol Clin Pract Date: 2021-10
Authors: Yara Mikhaeil-Demo; Eric Holmboe; Elizabeth E Gerard; Diane B Wayne; Elaine R Cohen; Kenji Yamazaki; Jessica W Templer; Danny Bega; George W Culler; Amar B Bhatt; Neelofer Shafi; Jeffrey H Barsuk Journal: J Grad Med Educ Date: 2021-04-16
Authors: Paulina S C Kliem; Kai Tisljar; Sira M Baumann; Pascale Grzonka; Gian Marco De Marchis; Stefano Bassetti; Roland Bingisser; Sabina Hunziker; Stephan Marsch; Raoul Sutter Journal: J Clin Med Date: 2022-01-15 Impact factor: 4.241