Jillian Gregory, DO, (she/her/hers)
Pediatric Intensivist
Maine Medical Center
Portland, Maine
Disclosure information not submitted.
Andrew Cohen, MD
Pediatric Resident Physician
Mass General Hospital, United States
Disclosure information not submitted.
Anya Cutler, MS, MPH
Research Analyst
Maine Medical Center, United States
Disclosure information not submitted.
Alexa Craig, MD
Pediatric Neurologist
Maine Medical Center, United States
Disclosure information not submitted.
Title: Morbidity Associated With Treatment Deviation From Pediatric Status Epilepticus Guidelines
Introduction: Treatment guidelines for the management of pediatric status epilepticus (SE) are often institution specific. These evidence-based guidelines included a tiered approach to medication administration, utilizing benzodiazepines as the first tier. When given in excessive amounts, benzodiazepines can cause respiratory depression. We aim to characterize deviation from hospital-based SE treatment guidelines, specifically evaluating benzodiazepine dose and the need for intubation.
Methods: Fifty-five pediatric SE Pediatric Intensive Care Unit (PICU) admissions to Maine Medical Center from May 2019 to May 2021 were identified by transport logs and ICD-10 codes. Patient demographics, dosing of benzodiazepines, adherence to our protocol, and the need for intubation were recorded. Benzodiazepines included intravenous lorazepam and midazolam. The cohort was divided between those treated according to the SE protocol (benzodiazepine dose < = 0.2mg/kg) versus those who had high dose benzodiazepine ( > 0.2mg/kg).
Results: The median age was 5.7 years (IQR 2.1, 12.8), 24 (44%) were female and 37 (67%) were transported from an outside hospital. Twenty-nine (53%) received high-dose benzodiazepines (median 0.34mg/kg [IQR 0.29-0.54]) and 26 (47%) received appropriate-dose benzodiazepines (median 0.10 mg/kg [IQR 0.05,0.15], p< 0.001). Patients who received high dose were more likely to be younger (median 32 months [IQR 14-83 months] vs 104 months [IQR 48-178 months]), p=.0.01 and weigh less (median 13 kg [IQR 11-28 kg] vs 32 kg [IQR 19-54kg]), p=0.032. The high-dose group was 6.6 times more likely to be intubated controlling for whether the protocol was followed, the location of care (tertiary versus community hospital), and age of patient (p=0.02).
Conclusions: Children admitted to the PICU for SE and given high doses of benzodiazepines were more likely to be intubated. Interventions that increase physician adherence to guidelines of SE treatment in children will likely reduce excessive benzodiazepine administration and the need for intubation. Improving accurate weight measurement for our youngest patients may also improve dosing accuracy. We plan to conduct a qualitative needs assessment of physicians in Maine emergency rooms to determine effective education or awareness strategies.