Abstracts

Rationale: Benzodiazepines such as intranasal (IN) midazolam and per rectum (PR) diazepam are initial prehospital treatment options for prolonged seizures or seizure clusters. Several studies analyzed their effectiveness and pharmacodynamics. IN midazolam is cheaper, more efficacious, has fewer side effects, and is associated with fewer hospital admissions when compared to PR diazepam. However, limited literature exists in regards to which patients receive IN midazolam compared to PR diazepam. In addition, because of its relative novelty, little is known about which medication is more cost-effective when analyzing utilization. Methods: Our study is a retrospective cohort design and was done using the electronic medical record at a large academic tertiary medical center. We sought to investigate connections between patient demographics, healthcare utilization, prescription use, and refills. Subjects were patients with epilepsy ages 0-22 years prescribed IN midazolam, PR diazepam, or both. Statistical analysis was completed to compare these groups of patients. Results: A total of 5458 patients were pulled that met the criteria stated above. Patients prescribed IN midazolam tended to be 3.38 years older than those prescribed PR diazepam (95% confidence interval is 2.98 ?" 3.77). Patients in the IN midazolam group had significantly lower ED visits (p < 0.0001) and hospitalizations (p < 0.0001) compared to patients in the PR diazepam group. In addition, fewer patients in the IN midazolam group had a history of status epilepticus than those in the PR diazepam group (p=0.008). We also collected information regarding the various co-morbidities that patients had in each group. Conclusions: Previous literature demonstrated that IN midazolam is not only more effective than PR diazepam. In addition, patients with IN midazolam had decreased utilization of the ED and lower unplanned hospitalizations. Patients that receive IN midazolam tend to be older than those that receive PR diazepam. Patients getting IN midazolam also had less documentation of status epilepticus which may explain the difference in healthcare utilization. However, the results are significant because they further substantiate the cost-effective benefits of prescribing IN midazolam as compared to PR diazepam. References: 1. Holsti M, Sill BL, Firth SD, Filloux FM, Joyce SM, Furnival RA. Prehospital intranasal midazolam for the treatment of pediatric seizures. Pediatr Emerg Care 2007;23:148-153. 2. Fisgin T, Gurer Y, Tezic T, et al. Effects of intranasal midazolam and rectal diazepam on acute convulsions in children: prospective randomized study. Journal of child neurology 2002;17:123-126. 3. Bhattacharyya M, Kalra V, Gulati S. Intranasal midazolam vs rectal diazepam in acute childhood seizures. Pediatric neurology 2006;34:355-359. Funding: Study supported with an unrestricted investigator initiated research grant from Upsher-Smith Laboratories.