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Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation

Published online by Cambridge University Press:  04 March 2015

Geneviève Tourigny-Ruel ,
Dubravka Diksic ,
Elise Mok  and
David McGillivray
Geneviève Tourigny-Ruel*
Affiliation:
Division of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC
Dubravka Diksic
Affiliation:
Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, QC
Elise Mok
Affiliation:
Division of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC
David McGillivray
Affiliation:
Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, QC
*
1000 Gordon, App. 411, Montréal, QC H4G 2S2; [email protected]

Abstract

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Objective:

To evaluate the efficacy and safety of a simple linear midazolam-based protocol for the management of impending status epilepticus in children up to 18 years of age.

Methods:

This is a descriptive, quality assessment, retrospective chart review of children presenting with the chief complaint of seizure disorder in the emergency department (ED) of a tertiary care pediatric hospital and a triage category of resuscitation or urgent from April 1, 2009, to August 31, 2011. In children with at least one seizure episode in the ED treated according to the linear protocol, three main outcomes were assessed: compliance, effectiveness, and complications.

Results:

Of the 128 children meeting the above study criteria, 68 had at least one seizure episode in the ED, and treatment was required to terminate at least one seizure episode in 46 of 68 patients (67.6%). Fifty-five seizure episodes were treated in the 46 patients: 51 of 55 seizure episodes were treated with midazolam (92.7%) and 4 of 55 with lorazepam or diazepam (7.3%). Of those treated with midazolam, 86.3% (44 of 51) were successfully treated with one or two doses of midazolam. The median seizure duration for all treated patients was 6 minutes. Of the 42 patients treated with midazolam, 7 required either continuous positive airway pressure or intubation, and two patients were treated for hypotension. One patient died of pneumococcal meningitis.

Conclusion:

This simple linear protocol is an effective and safe regimen for the treatment of impending status epilepticus in children.

Keywords

midazolampediatric emergencyquality assuranceseizure protocolstatus epilepticus
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 4 , July 2014 , pp. 304 - 313
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

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