小儿惊厥性难治性癫痫持续状态的治疗时间：周末效应。
Time to Treatment in Pediatric Convulsive Refractory Status Epilepticus: The Weekend Effect.
机构信息
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Child Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Pediatric Neurology Unit, Department of Pediatrics, Hospital Universitari Son Espases, Universitat de les Illes Balears, Palma, Spain.
出版信息
Pediatr Neurol. 2021 Jul;120:71-79. doi: 10.1016/j.pediatrneurol.2021.03.009. Epub 2021 Mar 26.
BACKGROUND
Time to treatment in pediatric refractory status epilepticus is delayed. We aimed to evaluate the influence of weekends and holidays on time to treatment of this pediatric emergency.
METHODS
We performed a retrospective analysis of prospectively collected observational data of pediatric patients with refractory status epilepticus.
RESULTS
We included 329 patients (56% males) with a median (p25 to p75) age of 3.8 (1.3 to 9) years. The median (p25 to p75) time to first BZD on weekdays and weekends/holidays was 20 (6.8 to 48.3) minutes versus 11 (5 to 35) minutes, P = 0.01; adjusted hazard ratio (HR) = 1.20 (95% confidence interval [CI]: 0.95 to 1.55), P = 0.12. The time to first non-BZD ASM was longer on weekdays than on weekends/holidays (68 [42.8 to 153.5] minutes versus 59 [27 to 120] minutes, P = 0.006; adjusted HR = 1.38 [95% CI: 1.08 to 1.76], P = 0.009). However, this difference was mainly driven by status epilepticus with in-hospital onset: among 108 patients, the time to first non-BZD ASM was longer during weekdays than during weekends/holidays (55.5 [28.8 to 103.5] minutes versus 28 [15.8 to 66.3] minutes, P = 0.003; adjusted HR = 1.65 [95% CI: 1.08 to 2.51], P = 0.01).
CONCLUSIONS
The time to first non-BZD ASM in pediatric refractory status epilepticus is shorter on weekends/holidays than on weekdays, mainly driven by in-hospital onset status epilepticus. Data on what might be causing this difference may help tailor policies to improve medication application timing.
背景
儿科难治性癫痫持续状态的治疗时间延迟。我们旨在评估周末和节假日对这种儿科急症治疗时间的影响。
方法
我们对前瞻性收集的儿科难治性癫痫持续状态患者的观察数据进行了回顾性分析。
结果
我们纳入了 329 名患者（男性占 56%），中位（25%至 75%分位数）年龄为 3.8（1.3 至 9）岁。工作日和周末/节假日首次给予苯二氮䓬的中位数（25%至 75%分位数）时间分别为 20（6.8 至 48.3）分钟和 11（5 至 35）分钟，P=0.01；调整后的危险比（HR）为 1.20（95%置信区间[CI]：0.95 至 1.55），P=0.12。工作日首次给予非苯二氮䓬类抗癫痫药物的时间长于周末/节假日（68[42.8 至 153.5]分钟与 59[27 至 120]分钟，P=0.006；调整后的 HR 为 1.38[95%CI：1.08 至 1.76]，P=0.009）。然而，这种差异主要是由院内起病的癫痫持续状态驱动的：在 108 名患者中，首次给予非苯二氮䓬类抗癫痫药物的时间在工作日长于周末/节假日（55.5[28.8 至 103.5]分钟与 28[15.8 至 66.3]分钟，P=0.003；调整后的 HR 为 1.65[95%CI：1.08 至 2.51]，P=0.01）。
结论
儿科难治性癫痫持续状态首次给予非苯二氮䓬类抗癫痫药物的时间在周末/节假日短于工作日，主要由院内起病的癫痫持续状态驱动。关于可能导致这种差异的原因的数据可能有助于制定政策以改善药物应用时机。
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