In pediatric patients with convulsive refractory status epilepticus (rSE), both intermittent rSE and out-of-hospital rSE onset are independently associated with longer delays to administration of the first benzodiazepine (BZD) and the first non-BZD antiepileptic drug (AED), according to the results of a prospective, observational study published in Neurology.
The current study was performed between June 2011 and March 2017 in pediatric patients with rSE. A Cox proportional hazards model was used to assess all possible risk factors related to treatment delays. A total of 219 patients were evaluated, (52.5% male; median age, 3.9 years). In 64.4% (141 of 219) of participants, rSE began out of the hospital, and in 35.6% (78 of 219), rSE began in the hospital. Median time from seizure onset to treatment with first BZD was 16 minutes (range 5-45 minutes); 63 minutes (range 33-146 minutes) to first non-BZD AED; and 170 minutes (range 107-539 minutes) to first continuous infusion.
Factors linked to more delays in administration of first BZD were intermittent rSE (hazard ratio [HR] 1.54; 95% CI, 1.14-2.09; P =.0467) and out-of-hospital rSE onset (HR 1.5; 95% CI, 1.11-2.04; P =.0467). Factors associated with more delays in administration of the first non-BZD AED were intermittent rSE (HR 1.78; 95% CI, 1.322.4; P =.001) and out-of-hospital rSE onset (HR 2.25; 95% CI, 1.67-3.02; P =.0001). None of the factors evaluated were linked with delayed administration of continuous infusion.
The investigators concluded that these findings should help identify targets for intervention to reduce the overall time to treatment in this population.
Sánchez Fernández I, Gaínza-Lein M, Abend NS, et al; Pediatric Status Epilepticus Research Group (pSERG). Factors associated with treatment delays in pediatric refractory convulsive status epilepticus. Neurology. 2018;90:e1692-e1701.