A 5-Year Audit of Paediatric Patients Presenting to an Emergency Department with Status Epilepsy Requiring Second-Line Medication

Abstract

Aim: Audit management of children presenting to Paediatric Emergency Department (PED) who require second-line medication for seizure control.

Method: Retrospective electronic chart review over a 5-year period (March 2015 to March 2020) of children aged 0–18 years who presented to PED at Children's Health Ireland at Temple Street. Inclusion criteria were patients with a seizure over 5 min that required second-line medication identified through symphony databases from children diagnosed as status epilepsy. Management was assessed against hospital protocol. Children with a specific patient plan were excluded. Data collected included: epidemiological, temperature, trauma, previous seizure, developmental history, family history, medication given, focality, blood tests, vascular access, intubation and neuroimaging.

Result: 88 of 380 patients included. Age range: 54% were 1–5 years, 15% were under 1 year, and 31% were aged 6–18 years. Fifty-seven percent were male, 72% were afebrile seizures and 7% had a history of trauma. Sixty-seven percent had a previous history of seizure. Sixty-seven percent had a generalized seizure and 33% had focal seizure. Thirty-eight percent of patients had neuroimaging and 5% had abnormal neuroimaging. Thirty-eight percent of patients had no documented developmental history and 14% had documented family history of epilepsy. Sixty-five percent of patients received benzodiazepines pre-hospital. Blood sugar levels were documented in 92%. Blood gas showed respiratory acidosis in majority of patients and only three patients had high lactate. Four percent required intraosseous access. Seizure control with second-line medication was achieved in 49% and 10% required intubation. Only 47% of patients were managed as per hospital guidelines.

Conclusion: Most patients (65%) had their management started pre-hospital to control the seizure and minimize morbidity and mortality. More training regarding the protocol for management of status epilepticus is needed in the PED to improve documentation of predisposing factors, ensure appropriate neuroimaging, appropriate timing of interventions and medication given as per protocol.