Abstracts

Rationale: Management of pediatric patients presenting to the ED with seizures is a clinical challenge for all caregivers The objective was to assess the overall management of pediatric patients (1 month-15years) presenting to the ED participants in the Illinois Emergency Medical Services for Children (EMSC) program as part of a Quality Improvement (OI) program in 2011. Methods: A web-based survey including a survey of practice/policy of care of patients with simple febrile seizure (SFS), as well as the first unprovoked seizure (unP) and status epilepticus (SE) was sent to the 119 participating EDs. In addition, there was a request for record review of up to 10 pts with SFS.. Results: Survey: Response rate was 88% (105/119 EDs). Of note, only 44% of EDs have a documented policy/protocol/guideline addressing overall management of seizures (71% include pediatrics); of these only 19% address SE. In house (24/7) pediatric neurology coverage is present in 12% of facilities with an additional 10% providing limited coverage. Also, 28% of EDs reported no pediatric or adult neurology coverage. SFS management included obtaining laboratory blood tests such as electrolytes (59%), blood culture (58%) and CBC with differential (74%) but only 2% of EDS routinely do lumbar puncture (LP). Record review: SFS: There were 751 patients from 100 hospitals. Prehospital glucose check was done in 34%. Only 4% had an LP, and 12% head CT in the ED. If the child was actively seizing on ED arrival, 6% received anti-epileptic medication which was given in 50% of patients (83% within 15 minutes) Conclusions: Even though the AAP has a policy on the evaluation of a child with a SFS, it is rarely followed. In addition, best practice management includes documented protocol and availability of neurologist. Educational program and direct feedback are underway for participating EDS in EMSC program.