Abstracts

Rationale: Treatment delay for seizures can lead to longer seizure duration. A relationship with major adverse short-term outcomes, such as death, has not been demonstrated. Methods: This multi-center prospective observational study included pediatric patients with refractory convulsive status epilepticus, admitted from 2011 to 2015, in whom the status epilepticus did not stop after at least two anti-seizure medications. We evaluated whether a delayed initial treatment of the first benzodiazepine (BZD), defined as ?-10 minutes from seizure onset, was associated with unfavorable short-term outcomes. Results: We studied 183 patients (97 males, 53%) with a median (p25-p75) age of 4.2 (1.3-10) years. SE started in the pre-hospital setting in 117 (64.1%) patients. Sixty-three (34.4%) patients received their first BZD < 10 minutes of seizure onset, and 120 (65.6%) patients received the first BZD ?-10 minutes. There was no difference in the frequency of a low first BZD dose between the two groups (p=0.4). After controlling for structural etiology, age, and febrile status epilepticus, patients who received the first BZD ?-10 minutes from seizure onset had higher odds of death (OR 7.7; 95% CI 1.11, +8; p < 0.05), greater odds of receiving one or more continuous infusion (OR 2.2; 95%CI 1.2, 4.3; p < 0.05), less often returned to baseline at hospital discharge (OR 2.3; 95%CI 1.0, 5.2; p < 0.05), had longer convulsive seizure duration (OR 2.8; 95% CI 1.4, 5.5; p < 0.01), and required more time to regain consciousness (OR 2.6; 95%CI 1.3, 5.3; p < 0.01). There were trends toward longer length of stay on the intensive care unit (OR 1.8; 95%CI 0.9, 3.5; p=0.08), longer intubation duration (OR 2.1; 95%CI 0.9, 4.9; p=0.08), more frequent hypotensive episodes (OR 2.1; 95%CI 0.9, 4.4; p=0.05) and other medical complications (OR 2.1; 95%CI 0.9, 4.6; p=0.06). Conclusions: In patients with refractory status epilepticus, a delay in administering the first BZD, defined as ?-10 minutes from seizure onset, is associated with multiple adverse short-term outcomes including higher mortality, the need of more frequent continuous infusions, lower rates of return to baseline function at hospital discharge, longer convulsion duration, and longer time to regain consciousness. (Supported by the Pediatric Epilepsy Research Foundation). Funding: This study and consortium was funded by the Epilepsy Foundation of America (EF-213583, Targeted Initiative for Health Outcomes), by the American Epilepsy Society/Epilepsy Foundation of America Infrastructure Award, and by the Pediatric Epilepsy Research Foundation.