Abstracts

Rationale: Time from seizure onset to treatment initiation should be prompt to reduce morbidity and mortality associated with status epilepticus (SE). The duration from seizure onset to initial treatment had been previously evaluated from 1989-1994 using a SE database of the greater Richmond area and the results demonstrated frequent delay of treatment. This study will analyze recent pre-hospital and emergency department (ED) treatment of pediatric SE in the greater Richmond area. Methods: Subjects were children, age 1 month to 18 years, who were part of a prospective SE database that consists of patients evaluated at Virginia Commonwealth University Hospital (VCU) from 2003 to 2011. SE was defined as seizure lasting 30 minutes. A panel reviewed each chart to determine the seizure start and end time as part of the prospective database recruitment. The inclusion criteria for this study were age, chief complaint of seizure and record availability of ED evaluation. Febrile seizures were excluded. We reviewed the emergency medical service (EMS) and ED management, including seizure recognition, medication administration and respiratory support. A standardized data entry system was used to create a database of the 79 afebrile pediatric SE cases from 2003-2011. The database was analyzed using JMP software.Results: Of the 79 children, 76 (96%) required an antiepileptic drug (AED) to terminate SE. Median duration of SE was 65 minutes. The median time from seizure onset to first dose of AED was 40 minutes (range 2-310 minutes). The majority of patients (65%) had a known history of seizures. Three children received no AED to terminate SE. Ten children (13%) were given first AED by family, 29 (37%) by EMS and 40 (51%) by ED. The number of AEDs given to each subject ranged from 0-4 (median 1) and doses of AED ranged from 1-8 (median 2). Thirty three percent of those receiving an AED by family or EMS (13/39) had termination of SE prior to ED evaluation. Twenty-four children (30%) received respiratory support. There was no significant difference in seizure duration between the respiratory support group and non-respiratory support group. Conclusions: Pediatric SE is a neurological emergency that requires recognition and treatment. Children frequently require medication to terminate SE, but treatment of these children with AEDs is significantly delayed, and has not improved from prior studies. Multiple studies have supported early treatment of SE, but the majority of these pediatric SE patients did not receive treatment in the pre-hospital setting. This significant delay in treatment supports the need for further education.