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Protocol-Driven Management of Convulsive Status Epilepticus at a Tertiary Children’s Hospital

A Quality Improvement Initiative

Cassel-Choudhury, Gina, DO1; Beal, Jules, MD2; Longani, Neha, MD3; Leone, Bridget, MD2; Rivera, Ruby, MD4; Katyal, Chhavi, MD1

Pediatric Critical Care Medicine: January 2019 - Volume 20 - Issue 1 - p 47–53
doi: 10.1097/PCC.0000000000001816
Neurocritical Care

Objectives: Convulsive status epilepticus is a medical emergency. Prompt treatment has been shown to decrease progression to refractory convulsive status epilepticus. We aimed to reduce time to second-line anti-seizure medication through implementation of a standardized treatment protocol.

Design: Quality improvement project. We constructed a multidisciplinary team and completed Plan-Do-Study-Act cycles to achieve the project aim.

Setting: A tertiary care children’s hospital.

Patients: Patients presenting to the Children’s Hospital at Montefiore emergency department with convulsive status epilepticus or new-onset seizures during admission to Children’s Hospital at Montefiore.

Interventions: Implementation of a standardized treatment protocol, uploading the protocol to the hospital’s intranet, adding anti-seizure medications to the hospital’s Pyxis system, and creating a standardized convulsive status epilepticus order set in the electronic medical record. The primary outcome measure was time from order to administration of second-line anti-seizure medication, and secondary outcome was total seizure time.

Measurements and Main Results: Seventy-eight patients were analyzed, including 41 from the baseline period (January 2014 through June 2015) and 37 from the postintervention period (July 2015 through December 2016). The median time to administration of second-line anti-seizure medication decreased from 52 to 21 minutes (p = 0.001) and total seizure time from 65 to 31 minutes (p = 0.09).

Conclusions: A standardized treatment protocol for convulsive status epilepticus decreased time to administration of second-line therapy by 60%, but there was no statistically significant decrease in total seizure time.

1Division of Critical Care, Department of Pediatrics, The Children’s Hospital at Montefiore, Bronx, NY.

2Division of Child Neurology, Department of Neurology, The Children’s Hospital at Montefiore, Isabelle Rapin, Bronx, NY.

3Division of Critical Care, Department of Pediatrics, Nemours Children’s Hospital, Orlando, FL.

4Division of Emergency Medicine, Department of Pediatrics, The Children’s Hospital at Montefiore, Bronx, NY.

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The authors have disclosed that they do not have any potential conflicts of interest.

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©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies