Abstracts

Rationale: Status epilepticus (SE), the second most common neurological emergency (Holtkamp, 2011) is seen by neurologists as well as primary care practitioners. Early recognition and appropriate treatment of SE may decrease patient morbidity and mortality which can be very high in infants and elderly population. Wide variation in training exists among medical schools and in residency training programs provided to non-neurologists. This prospective survey evaluates the ability of primary care attending physicians (AP) and resident physicians (RP) to properly define SE and their knowledge of first and second line antiepileptic drug treatment.Methods: From September 2008 to September 2009 an institutional review board approved survey was distributed to 122 non-neurologist primary care physicians at four Central New Jersey 350 to 500 bedded teaching hospitals. Of this group 66 were AP and 56 RP. The surveyor was present while the questionnaire was completed so that no ancillary materials could be accessed by participants. The questions included the following: What field of medicine do you practice? How do you define status epilepticus? What is the recommended first line medication for the treatment of SE in adults? What is the recommended second line medication for the treatment of SE? We reviewed the entire data set of both AP and RP responses and compared the groups utilizing chi square analysis. Results: Fifty one percent of AP could adequately define SE, while 85% of RP provided the correct answer (P= 0.001). Lorazepam as the first line of treatment of SE was selected by 68% of AP while 92% of RP chose this answer (P= 0.001) (Lowenstein et al,1999). Forty five percent of AP and 56% of RP correctly answered phenytoin or fosphenytoin as second line treatment of SE (P= 0.232) (Dodson et al, 1993, Lowenstein et al,1999).Conclusions: SE is a common life threatening neurological emergency which carries high morbidity and mortality if not recognized and managed promptly. SE is often seen and managed by primary care physicians. RP were better able to define SE and knew which medication to administer initially. Beyond initial therapy (lorazepam), which does fail in a significant proportion, (Treiman et al, 1998), second line therapy for persistent SE was known by less than half of the AP and by fifty six percent of RP. Advanced and Basic Cardiac Life Support and National Institute of Health Stroke Scale scoring have now become mandatory training requirements in many allied health care fields. Our results support the need for structured training for health care providers to properly recognize and treat SE.