Abstracts

Rationale: Convulsive status epilepticus (CSE) is associated with significant morbidity and mortality. When physicians adhere to published, evidence-based (EB) CSE treatment guidelines, CSE-associated morbidity and mortality are minimized. The purpose of this study is to determine knowledge of established EB CSE treatment guidelines among ED physicians and Neurologists at our institution. Methods: A 10 item multiple-choice questionnaire was developed to test knowledge of EB CSE treatment guidelines (6 questions) and related diagnostic or therapeutic concerns (e.g. important differences between phenytoin and fosphenytoin, 4 questions). The anonymous questionnaire was administered to ED and Neurology faculty and residents. Descriptive frequencies were used to analyze survey responses. t-tests were used to test for differences in mean correct score between ED and Neurology physicians. Results: Response rates were ED faculty 70%, ED Residents 80%, Neurology faculty 69% and Neurology residents 92%. Mean correct answers for each group were as follows: ED faculty 51.0%; ED residents 50.0%; Neurology faculty 55.9%; Neurology residents 53.4%. There was a statistically significant difference in correct response rate between ED and Neurology physicians on 3 questions. 1) A question addressing the first step in CSE management (ED 57% vs Neurology 26%; p = 0.001); 2) A question regarding total correct benzodiazepine dose (Neurology 53% vs ED 29% ; p=0.008) and 3) the next step in medication management after initial benzodiazepine treatment (Neurology 88 % vs ED 62%; p = 0.002). Conclusions: The dissemination and/ or acceptance of established EB CSE treatment guidelines and related data to ED and neurology physicians is inadequate at our institution. While overall performance in both departments was poor, the questionnaire revealed relative strengths and weaknesses in knowledge in each department. An educational intervention could improve both adherence to EB CSE treatment guidelines at DMC, and patient outcomes.