Abstracts

Rationale: Time to administration of antiepileptic drugs (AEDs) in SE is often longer than recommended. The objective of this study is to identify factors associated with treatment delays in refractory pediatric convulsive 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. rSE was defined as status epilepticus that continued after the administration of at least two AEDs including at least one non-benzodiazepine AED (non-BZD AED) or the use of continuous infusion. The main outcome was time from seizure onset to administration of AEDs expressed as median (p25-p75): first benzodiazepine (BZD), first non-BZD AED, and first continuous infusion. We evaluated continuous (single prolonged seizure) versus intermittent (several seizures without return to baseline function) rSE, in-hospital versus out-of-hospital rSE onset, the period 2011-2014 versus the period 2015-2017, day versus night, first half versus last half of the academic year, and race as factors potentially associated with treatment delays in a Cox proportional hazards model controlling for etiology, prior diagnosis of epilepsy, prior episode of SE, and age. Results: We studied 219 patients (53% males) with a median (p25-p75) age of 3.9 (1.2-9.5) years. SE episodes started out-of-hospital in 141 (64.4%) and in-hospital in 78 (35.6%) patients. The median (p25-p75) time from seizure onset to first BZD was 16 (5 – 45) minutes and to first non-BZD AED was 63 (33 – 146) minutes. Among 107 patients who received at least one continuous infusion, time to first continuous infusion was 170 (107 – 539) minutes. Factors associated with more delays to administration of the first BZD were intermittent SE HR: 1.54 (95% CI: 1.14 – 2.09), p = 0.0467 and out-of-hospital 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 SE HR: 1.78 (95% CI: 1.32 – 2.4), p = 0.001and out-of-hospital 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 (Figure 1). Among the 141 patients with out of hospital onset, the median (p25-p75) time to first BZD administration was 20 (8 – 55) minutes and to first non-BZD AED administration was 80 (45 – 165) minutes. Among 71 patients who received at least one continuous infusion, the median (p25-p75) time to first continuous infusion was 164 (97.5 – 641) minutes. In the population with out-of-hospital SE onset the factor associated with more delay to the first BZD was no prior SE [HR: 2.32 (95% CI: 1.58 - 3.42), p = 0.0053]. The factor associated with more delay to the first non-BZD AED was intermittent SE [HR: 2.33 (95% CI: 1.58 - 3.42), p = 0.0002. None of the studied factors were associated with a delayed administration of continuous infusions (Figure 2). Conclusions: Intermittent rSE and out-of-hospital rSE onset are independently associated with longer delays to treatment in pediatric rSE. (Supported by the Pediatric Epilepsy Research Foundation and the Epilepsy Research Fund) Funding: This study  was supported by the Pediatric Epilepsy Research Foundation and the Epilespy Research Fund.