Firn Eliza T, Jonas Rinat, Douglass Laurie M, Walsh Barbara M
Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA.
Open Access Emerg Med. 2025 May 7;17:165-171. doi: 10.2147/OAEM.S507770. eCollection 2025.
Children with epilepsy are often presented to Community Emergency Departments (CEDs) for acute treatment of status epilepticus (SE). Timely medical management is imperative to prevent morbidity and mortality, and adherence to evidence-based guidelines improves outcomes for high stakes/low frequency events. Barriers to guideline adherent management in the CED setting are understudied; in-situ simulation (ISS) can be used to identify gaps in care for events such as pediatric SE.
The primary objective was to assess for deviations from evidence-based guidelines in the management of pediatric SE. A secondary objective was to explore potential barriers to practice within the evidence-based guidelines.
We conducted a prospective observational ISS pilot study examining representative CED teams caring for a simulated child in SE. The primary outcome was overall adherence to the pediatric SE guidelines as measured by 12 metrics: 5 non-pharmacologic (for example: delays in vital sign assessment, failure to time seizure) and 7 pharmacologic (for example: incorrect benzodiazepine dose, delay in benzodiazepine administration or escalation to antiseizure medication). Additional metrics including provider knowledge (recognition of status epilepticus) and resources (antiseizure medications stocked) were analyzed as process measures. We enrolled 4 interprofessional teams at 4 participating ED sites.
Overall, 0 of the 4 teams adhered to all 12 metrics. A barrier to timely administration of benzodiazepines for two of the sites came from attempting IV access repeatedly. No team referenced an up-to-date treatment algorithm based on current evidence-based guidelines.
Standardized ISS scenarios identified variability in adherence to the pediatric SE guideline across a pilot sample of local CEDs. Barriers to guideline-adherent care occurred at both individual and systems levels. The study was limited in scope to 4 pilot sites.
癫痫患儿常因癫痫持续状态（SE）的急性治疗而被送往社区急诊科（CED）。及时的医疗管理对于预防发病和死亡至关重要，而遵循循证指南可改善高风险/低频事件的治疗效果。在CED环境中，对于遵循指南管理的障碍研究不足；现场模拟（ISS）可用于识别小儿SE等事件的护理差距。
主要目的是评估小儿SE管理中与循证指南的偏差。次要目的是探讨循证指南内实践的潜在障碍。
我们进行了一项前瞻性观察性ISS试点研究，检查照顾模拟SE患儿的代表性CED团队。主要结局是通过12项指标衡量的对小儿SE指南的总体遵循情况：5项非药物指标（例如：生命体征评估延迟、癫痫发作计时失误）和7项药物指标（例如：苯二氮䓬剂量错误、苯二氮䓬给药延迟或升级使用抗癫痫药物）。包括提供者知识（癫痫持续状态的识别）和资源（储备的抗癫痫药物）在内的其他指标作为过程指标进行分析。我们在4个参与的急诊科站点招募了4个跨专业团队。
总体而言，4个团队中没有一个团队遵循所有12项指标。其中两个站点及时给予苯二氮䓬的一个障碍来自反复尝试建立静脉通路。没有团队参考基于当前循证指南的最新治疗算法。
标准化的ISS场景在当地CED的试点样本中发现了对小儿SE指南遵循情况的差异。遵循指南护理的障碍在个人和系统层面均有出现。该研究范围仅限于4个试点站点。
