Fesler Jessica R, Belcher Anne E, Moosa Ahsan N, Mays MaryAnn, Jehi Lara E, Pestana Knight Elia M, Lachhwani Deepak K, Alexopoulos Andreas V, Nair Dileep R, Punia Vineet
Epilepsy Center (JRF, ANM, LEJ, EMPK, DKL, AVA, DRN, VP), Neurological Institute, Cleveland Clinic, OH; Johns Hopkins University School of Education (AEB), Baltimore, MD; and Neurological Institute (MAM), Cleveland Clinic, OH.
Neurol Clin Pract. 2021 Oct;11(5):406-412. doi: 10.1212/CPJ.0000000000000922.
To determine whether a pocket card treatment algorithm improves the early treatment of status epilepticus and to assess its utilization and retention in clinical practice.
Multidisciplinary care teams participated in video-recorded status epilepticus simulation sessions from 2015 to 2019. In this longitudinal cohort study, we examined the sessions recorded before and after introducing an internally developed, guideline-derived pocket card to determine differences in the adequacy or timeliness of rescue benzodiazepine. Simulation participants were queried 9 months later for submission of a differentiating identification number on each card to assess ongoing availability and utilization.
Forty-four teams were included (22 before and 22 after the introduction of the pocket card). The time to rescue therapy was shorter for teams with the pocket card available (84 seconds [64-132]) compared with teams before introduction (144 seconds [100-162]) (U = 94; median difference = -46.9, 95% confidence interval [CI]: -75.9 to -21.9). The adequate dosing did not differ with card availability (odds ratio 1.48, 95% CI: 0.43-5.1). At the 9-month follow-up, 32 participants (65%) completed the survey, with 26 (81%) self-reporting having the pocket card available and 11 (34%) confirming ready access with the identification number. All identification numbers submitted corresponded to the hard copy laminated pocket card, and none to the electronic version.
A pocket card is a feasible, effective, and worthwhile educational tool to improve the implementation of updated guidelines for the treatment of status epilepticus.
确定口袋卡片治疗算法是否能改善癫痫持续状态的早期治疗，并评估其在临床实践中的使用情况和留存率。
多学科护理团队参与了2015年至2019年的癫痫持续状态模拟视频记录会议。在这项纵向队列研究中，我们检查了在引入内部开发的、基于指南的口袋卡片前后记录的会议，以确定抢救苯二氮䓬类药物的充分性或及时性的差异。9个月后，向模拟参与者询问每张卡片上的区分识别号码，以评估其持续可用性和使用情况。
纳入了44个团队（引入口袋卡片前22个，引入后22个）。有口袋卡片的团队抢救治疗时间较短（84秒[64 - 132]），而引入前的团队为144秒[100 - 162]）（U = 94；中位数差异 = -46.9，95%置信区间[CI]：-75.9至-21.9）。给药充分性与卡片可用性无关（优势比1.48，95%CI：0.43 - 5.1）。在9个月的随访中，32名参与者（65%）完成了调查，其中26名（81%）自我报告有口袋卡片，11名（34%）通过识别号码确认可随时获取。提交的所有识别号码均对应硬拷贝覆膜口袋卡片，无对应电子版的。
口袋卡片是一种可行、有效且有价值的教育工具，可改善癫痫持续状态治疗更新指南的实施。
