James Cook University, College of Public Health, Medical and Veterinary Sciences, Townsville, Queensland, Australia; James Cook University, College of Medicine and Dentistry, Townsville, Queensland, Australia; The Townsville Hospital, Department of Emergency Medicine, Townsville, Queensland, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
James Cook University, College of Medicine and Dentistry, Townsville, Queensland, Australia.
Seizure. 2018 Mar;56:104-109. doi: 10.1016/j.seizure.2018.01.025. Epub 2018 Feb 5.
Status epilepticus (SE) is a paediatric emergency with significant morbidity and mortality. Recommendations beyond first line care are not based on high quality evidence. Emergency physicians and neurologists are key stakeholders in managing this condition. A collaborative, widely consulted approach to identifying priorities can help direct limited research funds appropriately. The objectives of this study are to identify consensus research priorities in paediatric SE among experts and health consumers.
A three-stage Delphi process was conducted. Paediatric Neurologists and Emergency Physicians in Australia and New Zealand participated. Round one asked participants to generate three research questions important for further research in paediatric status epilepticus. Responses were refined into unique individual questions. Rounds two and three required participants to rate questions on a seven point ordinal scale. Health consumers were invited to participate by providing up to three problem areas that could be addressed by research.
54 experts and 76 health consumers participated in the process. Nine questions reached our definition of consensus "high priority", 21 questions achieved consensus "low priority" and seven questions did not achieve consensus. High priority areas included second line management including levetiracetam (efficacy, dose and timing), use of third line agents, induction of anaesthesia (timing and best agent), management of focal SE, and indicators of "subtle SE". Consumer priority areas included themes of treatment efficacy, aetiology, and community education.
We identified nine priority research questions in paediatric SE, congruent with the health consumer theme of treatment efficacy. Future research efforts should be directed towards these priority areas.
癫痫持续状态（SE）是一种儿科急症，具有较高的发病率和死亡率。除一线治疗外的推荐意见并非基于高质量证据。急诊医生和神经科医生是管理这种疾病的关键利益相关者。采用协作、广泛咨询的方法确定优先事项有助于合理引导有限的研究资金。本研究的目的是在儿科 SE 专家和卫生消费者中确定共识研究重点。
采用三阶段 Delphi 法进行研究。澳大利亚和新西兰的儿科神经科医生和急诊医生参与了这项研究。第一轮要求参与者提出三个对儿科 SE 进一步研究重要的研究问题。回应内容被细化为独特的个体问题。第二轮和第三轮要求参与者对问题进行七点有序标度评分。卫生消费者受邀通过提出最多三个可通过研究解决的问题领域参与进来。
54 名专家和 76 名卫生消费者参与了这一过程。9 个问题达到了我们定义的“高度优先”共识标准，21 个问题达成了“低度优先”共识，7 个问题未达成共识。高度优先领域包括二线管理，包括左乙拉西坦（疗效、剂量和时机）、三线药物的使用、麻醉诱导（时机和最佳药物）、局灶性 SE 的管理，以及“隐匿性 SE”的指标。消费者关注的领域包括治疗效果、病因和社区教育主题。
我们确定了儿科 SE 的九个优先研究问题，与治疗效果的卫生消费者主题一致。未来的研究工作应针对这些优先领域进行。
