Published evidence on delays in time to treatment for refractory convulsive status epilepticus (rSE) in children was not associated with a sustained reduction in time to treatment, but with an increase in the proportion of patients who received benzodiazepines (BZD) before hospital arrival, according to a study published in Neurology.
In this study, Fernandez and colleagues assessed the impact of published evidence on delays in time to treatment for status epilepticus (SE) by comparing time to treatment before (2011-2014) and after (2015-2019) publication, according to patient interviews and record review.
The researchers prospectively collected data from June 2011 to September 2019 on pediatric rSE patients aged 1 month to 21 years. The study cohort included 328 patients (56% male; median age 3.8 years), including 151 (46%) in the period 2011-2014 and 177 (54%) in the period 2015-2019.
The retrospective analysis suggested that published data on treatment delays for status epilepticus in children had no impact on the median time to first BZD (20 vs 15 minutes, P =.3919) or non-BZD anti-seizure medication (68 vs 65 minutes, P =.7328). Similarly, there was no difference in time to first continuous infusion (186 vs 160 minutes, P =.2236).
Data on time to hospital arrival was available for 157 patients with out-of-hospital rSE. Of these, at least 1 benzodiazepine was given before hospital arrival to 41 of 81 patients (50.6%) before and to 57 of 76 patients (75%) after publication of evidence of delays (P =.0018). The odds ratio (OR) remained significant following adjustment for potential confounders (OR, 4.35; 95% CI, 1.96-10.3; P =.0005).
Sensitivity analyses showed similar findings with no improvement in time to treatment after publication of evidence of delays in time to treatment.
The study had several limitations, including potential selection bias, inability to compare differences within individual centers, inability to compare results within the nonrefractory SE population, and potential information and recall bias.
The researchers concluded that in “a large multicenter consortium of leading pediatric hospitals, publication of evidence on delays in treatment of rSE among epileptologists and child neurologists did not translate into improvements in time to treatment, although it was associated with an increase in the proportion of patients who received at least one BZD before hospital arrival.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Fernández IS, Abend NS, Amengual-Gual M, et al. Association of guideline publication and delays to treatment in pediatric status epilepticus [published online July 1, 2020]. Neurology. doi:10.1212/WNL.0000000000010174