Multicenter Evaluation of Prehospital Seizure Management in Children
| Autor: | Manish I. Shah, Chelsea Stanford, Daniel G Ostermayer, John M. Carey, Nicole Fumo, Jonathan R. Studnek, E. Brooke Lerner, Lorin R. Browne |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Emergency Medical Services
medicine.medical_specialty Adolescent business.industry Infant Newborn Infant 030208 emergency & critical care medicine 030204 cardiovascular system & hematology Emergency Nursing 03 medical and health sciences Cross-Sectional Studies 0302 clinical medicine Seizures Child Preschool Emergency medicine Emergency Medicine Emergency medical services Humans Medicine Anticonvulsants Child business Retrospective Studies |
| Zdroj: | Prehospital Emergency Care. 25:475-486 |
| ISSN: | 1545-0066 1090-3127 |
| DOI: | 10.1080/10903127.2020.1788194 |
| Popis: | Seizures are a common reason why emergency medical services (EMS) transports children by ambulance. Timely seizure cessation prevents neurologic morbidity, respiratory compromise, and mortality. Implementing recommendations from an evidence-based pediatric prehospital guideline may enhance timeliness of seizure cessation and optimize medication dosing.We compared management of pediatric prehospital seizures across several EMS systems after protocol revision consistent with an evidence-based guideline.Using a retrospective, cross-sectional approach, we evaluated actively seizing patients (0-17 years old) EMS transported to a hospital before and after modifying local protocols to include evidence-based recommendations for seizure management in three EMS agencies. We electronically queried and manually abstracted both EMS and hospital data at each site to obtain information about patient demographics, medications given, seizure cessation and recurrence, airway interventions, access obtained, and timeliness of care. The primary outcome of the study was the appropriate administration of midazolam based on route and dose. We analyzed these secondary outcomes: frequency of seizure activity upon emergency department (ED) arrival, frequency of respiratory failure, and timeliness of care.We analyzed data for 533 actively seizing patients. Paramedics were more likely to administer at least one dose of midazolam after the protocol updates [127/208 (61%) vs. 232/325 (71%),Implementation of an evidence-based seizure protocol for EMS increased midazolam administration. Patients frequently received an incorrect weight-based dose. Future research should focus on optimizing administration of the correct dose of midazolam to improve seizure cessation. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|