Authors :
Presenting Author: Jay Kassiri, MD,PhD – University of Alberta
Cameron Elliott, MD,PhD – Pediatric Neurosurgeon, Surgery, University Of Alberta; Natarie Liu, MD – Pediatric Epileptologist, Pediatrics, University of Alberta; Grace Wang, MMATH – Statistician, Alberta Health Services; Barry Sinclair, MD – Pediatric Epileptologist, Pediatrics, University of Alberta
Rationale:
Pediatric status epilepticus (SE) is a time-sensitive medical emergency and delayed treatment is associated with significant morbidity and mortality. A standardized, evidence-based management algorithm is lacking for treating the affected population. Our objective was to carry out a retrospective study to understand the factors that are impacting the current management of pediatric SE of normally developing children across Alberta using linked health system databases.
Methods:
We identified all pediatric SE patients who visited emergency departments (EDs) in the Province of Alberta between 2012 and 2019 through
National Ambulatory Care Reporting System using the ICD10 code G41. We validated the G41 cohort by comparing to other seizure cohort (G40, R56) and with a sampled chart review to ensure that it captured SE reasonably well. Patient records were linked with Emergency Medical Services (EMS) data, Inpatient Discharge Abstract Database, and other health system databases to capture their demographics, socioeconomic status, prehospital and hospital investigations, treatment algorithms, lengths of stay, hospital admission and other outcomes. Results:
The study included 22,585 normally developing patients with SE presented to EDs. After validating patient demographics and clinical modalities with the inclusion criteria, only 412 patients with a median age of two years with SE were included in this study. Seventy percent of them arrived in ambulances, and during EMS transit, only 56% received treatment for SE. The median time to initial assessment at the pediatric EDs was 21 minutes versus 10 minutes at non-pediatric EDs. Proportions of patients who had labs and CT scans ordered in pediatric EDs were (27% and 42%) significantly different from non-pediatric EDs (42% and 14%). Medications were given more frequently in pediatric EDs (32% first line; 36% second line) than in non-pediatric EDs (12% first line; 14% second line). Lower socioeconomic groups were less likely to use pediatric EDs (43%) compared to others (73%). Of all patients presented to ED, 81% were admitted and 18% needed ICU level care.
Conclusions:
Using large-scale linked health system data, this study is the first to show that the management of pediatric status epilepticus is complex and varies across all stages of the health-care system. Larger prospective studies are needed to optimize the emergency management of pediatric SE at all stages of healthcare.
Funding: None