From the Clinic for Intensive Care Medicine (R.S., K.T., P.O., S.M.), University Hospital Basel; Department of Neurology (R.S., G.M.D.M.), University Hospital Basel; Medical Faculty (R.S., G.M.D.M., S.B., R.B., S.H., S.M.), University of Basel; Division of Internal Medicine (P.O., S.B.), University Hospital Basel; Department of Emergency Medicine (R.B.), University Hospital Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland.
Neurology. 2019 Nov 5;93(19):838-848. doi: 10.1212/WNL.0000000000008461. Epub 2019 Oct 8.
To quantify the quality of physicians' emergency first response to status epilepticus (SE) and to identify risk factors for nonadherence to treatment guidelines in a standardized simulated scenario.
In this prospective trial, 58 physicians (of different background) of the University Hospital Basel, a Swiss academic medical care center, were confronted with a simulated SE. Primary outcomes were time to (1) airway protection, (2) supplementary oxygen, and (3) administration of antiseizure drugs (ASDs).
All physicians recognized ongoing seizures. Airways were checked by 54% and protected by 16% within a median of 3.9 minutes. Supplementary oxygen was administered by 76% with a median of 2.8 minutes. First-line ASDs were administered by 98% (benzodiazepines 97% within a median of 2.9 minutes), and second-line ASDs by 57% within 8.1 minutes. Regarding secondary outcomes, the median time to monitor blood pressure and heart rate was 1.8 (interquartile range [IQR] 1.3-2.6) and 2.0 (IQR 1.4-2.7) minutes, respectively. Neurologic affiliation of physicians was associated with inadequate assessments of vital signs (odds ratio [OR] = 0.2; 95% CI 0.04-0.93) and most frequent administration of second-line ASDs (OR = 5.0; 95% CI 1.01-25.3). Knowing treatment guidelines and subjective certainty regarding SE diagnosis were associated with frequent administration of second-line ASDs (OR = 10.4; 95% CI 1.2-88.1).
Nonadherence to SE treatment guidelines is frequent. The lack of airway assessment and protection in the simulated clinical scenario of SE may increase mortality and promote treatment refractoriness related to aspiration pneumonia. Guideline-based clinical training is urgently needed to increase the quality of SE management.
ISRCTN registry (ID ISRCTN60369617; www.isrctn.com/ISRCTN60369617).
量化医生对癫痫持续状态（SE）的紧急初始反应的质量，并确定在标准化模拟场景中不遵守治疗指南的风险因素。
在这项前瞻性试验中，巴塞尔大学医院（瑞士学术医疗中心）的 58 名医生（不同背景）面临模拟 SE。主要结局是（1）气道保护、（2）补充氧气和（3）使用抗癫痫药物（ASD）的时间。
所有医生均识别到正在发作的癫痫。中位数为 3.9 分钟时，有 54%的医生检查了气道，有 16%的医生保护了气道。中位数为 2.8 分钟时，有 76%的医生提供了补充氧气。中位数为 2.9 分钟时，98%的医生（97%为苯二氮䓬类）使用了一线 ASD，中位数为 8.1 分钟时，57%的医生使用了二线 ASD。关于次要结局，中位数监测血压和心率的时间分别为 1.8（四分位距 [IQR] 1.3-2.6）和 2.0（IQR 1.4-2.7）分钟。医生的神经科专业与生命体征评估不足有关（优势比 [OR] = 0.2；95%CI 0.04-0.93），也与最常使用二线 ASD 有关（OR = 5.0；95%CI 1.01-25.3）。了解治疗指南和 SE 诊断的主观确定性与频繁使用二线 ASD 有关（OR = 10.4；95%CI 1.2-88.1）。
不遵守 SE 治疗指南的情况很常见。在 SE 的模拟临床场景中缺乏气道评估和保护可能会增加死亡率，并促进与吸入性肺炎相关的治疗抵抗。急需进行基于指南的临床培训，以提高 SE 管理的质量。
ISRCTN 注册表（ID ISRCTN60369617；www.isrctn.com/ISRCTN60369617）。
