Investigating Associations Between Nonadherence to Guideline-Recommended Treatment of Pediatric Seizures and Adverse Outcomes: A Canadian Feasibility Study.

Autor: Moreau M; Department of Pediatrics, Queen's University, Kingston, Ontario; Kingston Health Sciences Centre, Kingston, Ontario., Coo H; Department of Pediatrics, Queen's University, Kingston, Ontario., Pattathil N; Department of Pediatrics, Queen's University, Kingston, Ontario., Kukreti V; Department of Pediatrics, Queen's University, Kingston, Ontario; Department of Pediatrics, Lakeridge Health, Oshawa, Ontario., Brooks SC; Kingston Health Sciences Centre, Kingston, Ontario; Department of Emergency Medicine, Queen's University, Kingston, Ontario., Sehgal A; Department of Pediatrics, Queen's University, Kingston, Ontario; Kingston Health Sciences Centre, Kingston, Ontario. Electronic address: anupam.sehgal@kingstonhsc.ca.
Jazyk: angličtina
Zdroj: Pediatric neurology [Pediatr Neurol] 2024 Jul; Vol. 156, pp. 113-118. Date of Electronic Publication: 2024 Apr 26.
DOI: 10.1016/j.pediatrneurol.2024.04.021
Abstrakt: Background: Emerging evidence suggests that nonadherence to treatment guidelines for seizures may affect patient outcomes. We examined the feasibility of conducting a larger investigation to test this hypothesis in the pediatric population.
Methods: We retrospectively reviewed charts of patients aged ≤18 years who presented with seizure to the emergency departments of two Ontario hospitals in 2019 to 2021. Patients were grouped by seizure duration (<5 minutes [n = 37], ≥5 minutes [n = 41]). We examined nonadherence to guideline-recommended treatment, adverse outcomes (hospitalization, length of stay, respiratory complications), and missing values for key variables.
Results: Of 78 patients, 34 (44%) did not receive guideline-recommended treatment. Nonadherence was similar in the two groups (<5 minutes: 46%; ≥5 minutes: 41%). Common deviations included administering an antiseizure medication (ASM) for seizures of less than five minutes (46%), a delay (>10 minutes) between the first and second ASM doses (50%), and use of a benzodiazepine for the third dose (45%). Hospitalizations were common in both seizure duration groups (∼90%), whereas respiratory complications were relatively rare. Time of seizure onset was missing in 51% of charts, and none contained the time of first contact with emergency services when patients were transported by ambulance.
Conclusion: We found evidence of substantial nonadherence to guideline-recommended treatment of pediatric seizures. Medical records do not contain sufficient information to comprehensively investigate this issue. A multicenter prospective study is the most feasible option to examine the association between nonadherence to guideline-recommended treatment and patient outcomes.
Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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