与儿童难治性惊厥性癫痫持续状态治疗延迟相关的因素。
Factors associated with treatment delays in pediatric refractory convulsive status epilepticus.
机构信息
From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix.
出版信息
Neurology. 2018 May 8;90(19):e1692-e1701. doi: 10.1212/WNL.0000000000005488. Epub 2018 Apr 11.
OBJECTIVE
To identify factors associated with treatment delays in pediatric patients with convulsive refractory status epilepticus (rSE).
METHODS
This prospective, observational study was performed from June 2011 to March 2017 on pediatric patients (1 month to 21 years of age) with rSE. We evaluated potential factors associated with increased treatment delays in a Cox proportional hazards model.
RESULTS
We studied 219 patients (53% males) with a median (25th-75th percentiles [p-p]) age of 3.9 (1.2-9.5) years in whom rSE started out of hospital (141 [64.4%]) or in hospital (78 [35.6%]). The median (p-p) time from seizure onset to treatment was 16 (5-45) minutes to first benzodiazepine (BZD), 63 (33-146) minutes to first non-BZD antiepileptic drug (AED), and 170 (107-539) minutes to first continuous infusion. Factors associated with more delays to administration of the first BZD were intermittent rSE (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.14-2.09; = 0.0467) and out-of-hospital rSE onset (HR 1.5, 95% CI 1.11-2.04; = 0.0467). Factors associated with more delays to administration of the first non-BZD AED were intermittent rSE (HR 1.78, 95% CI 1.32-2.4; = 0.001) and out-of-hospital rSE onset (HR 2.25, 95% CI 1.67-3.02; < 0.0001). None of the studied factors were associated with a delayed administration of continuous infusion.
CONCLUSION
Intermittent rSE and out-of-hospital rSE onset are independently associated with longer delays to administration of the first BZD and the first non-BZD AED in pediatric rSE. These factors identify potential targets for intervention to reduce time to treatment.
目的
确定与儿童惊厥性难治性癫痫持续状态（rSE）患者治疗延迟相关的因素。
方法
本前瞻性观察性研究于 2011 年 6 月至 2017 年 3 月期间对儿童（1 个月至 21 岁）rSE 患者进行。我们在 Cox 比例风险模型中评估了与治疗延迟增加相关的潜在因素。
结果
我们研究了 219 名患者（53%为男性），中位（25 至 75 百分位数 [p-p]）年龄为 3.9（1.2-9.5）岁，其中 rSE 起始于院外（141 [64.4%]）或院内（78 [35.6%]）。从发作到治疗开始的中位（p-p）时间为首次苯二氮䓬（BZD）治疗为 16（5-45）分钟，首次非苯二氮䓬类抗癫痫药（AED）治疗为 63（33-146）分钟，首次连续输注治疗为 170（107-539）分钟。与首次 BZD 给药延迟相关的因素包括间歇性 rSE（风险比 [HR] 1.54，95%置信区间 [CI] 1.14-2.09； = 0.0467）和院外 rSE 发作（HR 1.5，95% CI 1.11-2.04； = 0.0467）。与首次非苯二氮䓬类 AED 给药延迟相关的因素包括间歇性 rSE（HR 1.78，95% CI 1.32-2.4； = 0.001）和院外 rSE 发作（HR 2.25，95% CI 1.67-3.02； < 0.0001）。研究中的任何因素均与连续输注治疗的延迟无关。
结论
间歇性 rSE 和院外 rSE 发作与儿童 rSE 患者首次 BZD 和首次非苯二氮䓬类 AED 治疗的延迟时间延长独立相关。这些因素确定了潜在的干预目标，以减少治疗时间。
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