Abstracts

Rationale: Pediatric status epilepticus (PSE) can be under-recognized by caregivers and healthcare providers. There are often delays in first anti-epileptic drug (AED) administration. Our goal was to evaluate timing and selection of AEDs in patients presenting in PSE to the pediatric emergency department (ED). Methods: We identified patients presenting to the ED with PSE from 2009-2015. Patients were included in the study population with physician-documented ICD-9 code of status epilepticus and medical records were used to verify timing of seizure onset, AED dosing, route and timing. Results: 142 patients had complete documentation to determine medication dosing and timing related to seizure-onset. Mean age was 65.5 months (range 1 month-228 months) with average duration of PSE was 129 min (range 5-1440 min). PSE was extinguished in less than 60 minutes in 53% of patients (73/138) and in less than 120 minutes in 78% (108/138) of our patient group (4 patients had unclear length of seizure). The average time to first AED dose (whether given by parent or given in ED) was 73 min (range 5-1200 min). First dose AED timing was delayed for most patients (timing of first dose AED after seizure onset, percentage of patients receiving dose in this timeframe): less than 5 min after seizure onset, 21% (31/142); less than 10 min, 31% (44/142); less than 30 min, 58% (83/142). Primary AED selection was varied. The most common first-line AED was intravenous (IV) lorazepam (72/142), followed by rectal valium (29/142), IV midazolam (11/142), intramuscular benzodiazepine (lorazepam (9/142) and midazolam (6/142), IV fosphenytoin (5/142), IV phenobarbital (3/142), IV levetiracetam (2/142) and benzodiazepines by other routes (5/142). Conclusions: The timing and selection of first-line AED is not standardized, though nearly all were treated with a benzodiazepine. Our data suggest that there are delays in first dose AED in patients presenting to our ED with PSE. This trend correlates with data from other institutions that examined timing of medications for children in refractory status and longer than recommend initial treatment at 5-20 minutes. Delays in medication administration may contribute to worse outcomes for patients with PSE. Further investigation is necessary to identify specific barriers to caregiver/provider recognition, availability of medications, and treatment of PSE. Funding: None.