紧急医疗服务对小儿癫痫持续状态的管理（pSERG队列研究）

Pediatric status epilepticus management by Emergency Medical Services (the pSERG cohort).

作者信息

Amengual-Gual Marta, Sánchez Fernández Iván, Vasquez Alejandra, Abend Nicholas S, Anderson Anne, Arya Ravindra, Barcia Aguilar Cristina, Brenton J Nicholas, Carpenter Jessica L, Chapman Kevin E, Clark Justice, Farias-Moeller Raquel, Gaillard William D, Glauser Tracy A, Goldstein Joshua L, Goodkin Howard P, Lai Yi-Chen, Mikati Mohamad A, Morgan Lindsey A, Novotny Edward J, Ostendorf Adam P, Payne Eric T, Peariso Katrina, Piantino Juan, Reece Latania, Riviello James J, Sannagowdara Kumar, Sheehan Theodore, Tasker Robert C, Tchapyjnikov Dmitry, Topjian Alexis A, Wainwright Mark S, Wilfong Angus, Williams Korwyn, Loddenkemper Tobias

机构信息

Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Universitat de les Illes Balears, Palma, Spain.

Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Department of Child Neurology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.

出版信息

Seizure. 2023 Oct;111:51-55. doi: 10.1016/j.seizure.2023.07.010. Epub 2023 Jul 16.

DOI:10.1016/j.seizure.2023.07.010

PMID:37523933

Abstract

PURPOSE

Delayed treatment in status epilepticus (SE) is independently associated with increased treatment resistance, morbidity, and mortality. We describe the prehospital management pathway and Emergency Medical Services (EMS) timeliness in children who developed refractory convulsive status epilepticus (RCSE).

METHODS

Retrospective multicenter study in the United States using prospectively collected observational data from June 2011 to March 2020. We selected pediatric patients (one month-21 years) with RCSE initiated outside the hospital and transported to the hospital by EMS.

RESULTS

We included 91 patients with a median (percentile-percentile) age of 3.0 (1.5-7.3) years. The median time from seizure onset to hospital arrival was 45 (30-67) minutes, with a median time cared for by EMS of 24 (15-36) minutes. Considering treatment by caregivers and EMS before hospital arrival, 20 (22%) patients did not receive any anti-seizure medications (ASM) and 71 (78%) received one to five doses of benzodiazepines (BZD), without non-BZD ASM. We provided the prehospital treatment flow path of these patients through caregivers and EMS including relevant time points. Patients with a history of SE were more likely to receive the first BZD in the prehospital setting compared to patients without a history of SE (adjusted HR 3.25, 95% CI 1.72-6.12, p<0.001).

CONCLUSION

In this multicenter study of pediatric RCSE, prehospital treatment may be streamlined further. Patients with a history of SE were more likely to receive prehospital rescue medication.

摘要

目的

癫痫持续状态（SE）的延迟治疗与治疗抵抗性增加、发病率和死亡率独立相关。我们描述了发生难治性惊厥性癫痫持续状态（RCSE）的儿童的院前管理路径和紧急医疗服务（EMS）及时性。

方法

在美国进行的一项回顾性多中心研究，使用2011年6月至2020年3月前瞻性收集的观察数据。我们选择了在院外发生RCSE并由EMS转运至医院的儿科患者（1个月至21岁）。

结果

我们纳入了91例患者，中位（百分位数-百分位数）年龄为3.0（1.5-7.3）岁。从癫痫发作开始到医院到达的中位时间为45（30-67）分钟，EMS护理的中位时间为24（15-36）分钟。考虑到在医院到达前由护理人员和EMS进行的治疗，20例（22%）患者未接受任何抗癫痫药物（ASM），71例（78%）接受了1至5剂苯二氮䓬类药物（BZD），未使用非BZD ASM。我们提供了这些患者通过护理人员和EMS的院前治疗流程路径，包括相关时间点。与无SE病史的患者相比，有SE病史的患者在院前环境中更有可能接受首次BZD治疗（调整后HR 3.25，95%CI 1.72-6.12，p<0.001）。