Abstracts

Adequate emergency pre-hospital treatment reduces seizure duration and thus the probability of children having a seizure lasting at least 30 minutes (CSE). Therefore, we hypothesize that in the general paediatric population those children that fail to respond to an adequate initial dose of pre-hospital treatment will be more likely to have refractory CSE than those that receive inadequate or no treatment. From an ongoing prospective population-based study, the North London convulsive STatus EPilepticus in childhood Surveillance Study (NLSTEPSS), we report on the effect of pre-hospital treatment of CSE. The methods for ascertainment of cases and data collection have been previously described (AES 2003). Data on choice and dose of antiepileptic drugs(AED) were compared to the Advanced Paediatric Life Support treatment guideline for CSE(3rd Ed). A Kruskal-Wallis ANOVA was used to investigate whether the median duration of CSE was different in children that received adequate, inadequate or no treatment. Chi-square testing was carried out to examine relationships between pre-hospital treatment in incident and non-incident cases, and the relationship to admission to PIC. 110 incident and 81 non-incident cases of CSE, of out of hospital onset, have been enrolled. Pre-hospital treatment was administered in 49(45%) incident and 62(77%) non-incident cases (p[lt]0.001). Rectal (PR) diazepam was the first AED administered in 116(95%) cases. In those children treated with PR diazepam the dosage was adequate in only 15(33%) incident and 10(17%) non-incident cases (p=0.02). The median duration of CSE was similar in all treatment groups (p=0.33), however those that received adequate pre-hospital treatment were more likely to require admission to PIC than those that received no or inadequate pre-hospital treatment (p=0.05). There was no evidence for increased respiratory insufficiency in those children adequately treated (p=0.95). Children with a first time episode of CSE are less likely to receive pre-hospital treatment than those with a recurrent episode, although those with first time events are more likely to receive an adequate dose. Pre-hospital treatment in children that ultimately have a seizure lasting at least 30 minutes does not reduce overall seizure length. However, children who fail to respond to adequate pre-hospital treatment are more likely to require PIC admission, suggesting that these children are more likely to have refractory CSE than those inadequately or not treated. Conversely, children inadequately or not treated in the pre-hospital setting are likely to respond to treatment in the hospital setting and not require PIC, suggesting that seizure duration would have been shorter in a large number if the initial dose were adequate.