Abstracts

Rationale: Convulsive status epilepticus (CSE) is a medical emergency. Prompt treatment has been shown to decrease progression to refractory CSE. Pediatric patients presenting with CSE often encounter treatment delays due to lack of standardization of management. We aimed to reduce time to second line antiepileptic drugs (AED) through implementation of a standardized treatment protocol. Methods: This is a quality improvement project constructed by a multidisciplinary team to improve the treatment of pediatric patients with CSE presenting to the Children’s Hospital at Montefiore (CHAM) emergency department and critical care unit. Representatives from Pediatric Critical Care, Pediatric Epilepsy, and Pediatric Emergency Medicine participated in the design and implementation of the project. Interventions included the creation of a standardized CSE treatment protocol based on the 2016 American Epilepsy Society guidelines which was uploaded to the hospital’s intranet, adding select AEDs to the hospital’s Pyxis system, and creating a standardized CSE order set in the electronic medical record. The primary outcome measure was total seizure time. Secondary outcome measures were time to administration of 2^nd line AED and hospital length of stay.  Results: Of 137 patients admitted to the hospital for CSE during the 3-year time period of the study, 78 patients requiring a second line AED were analyzed, including 41 from the baseline period and 37 from the post-intervention period. The two groups were similar in terms of age, gender, and the number diagnosed with epilepsy prior to presenting with CSE. The median time to administration of second line AED decreased from 52 to 21 minutes (p=0.001), and total seizure time from 65 to 31 minutes (p=0.064) after interventions were implemented. The hospital length of stay was a median of 4 days for our baseline and post intervention groups.  Conclusions: Using a multidisciplinary approach and relatively simple interventions, we were able to significantly decrease the time to second line AED therapy in children with CSE by 60%. Although the decrease in total seizure time did not achieve statistical significance, there was a clear trend toward decreased seizure duration by more than 50% in the post-intervention group. Hospital length of stay was unaffected; we have hypothesized that this may correlate with the patients’ underlying conditions rather than the seizure activity itself. Given the positive results, the treatment protocol and interventions were adopted as institutional practice throughout the children’s hospital.  Funding: None