Inappropriate emergency management of status epilepticus in children contributes to need for intensive care
- 1Neurosciences Unit, Institute of Child Health, University College London, and Great Ormond Street Hospital for Children NHS Trust, London, UK
- 2Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Correspondence to: Dr R F M Chin Neurosciences Unit, Institute of Child Health, University College London, and Great Ormond Street Hospital for Children NHS Trust, London WC1N 1EH, UK; r.chinich.ucl.ac.uk
- Received 19 November 2003
- Accepted 2 February 2004
- Revised 22 January 2004
Abstract
Objectives: To characterise the clinical features, emergency pre-paediatric intensive care (PIC) treatment, and course of status epilepticus (SE) in children admitted to PIC. This may provide insight into reasons for admission to PIC and provide a framework for the development of strategies that decrease the requirement for intensive care.
Design: Cross sectional, retrospective study.
Setting: A tertiary paediatric institution’s intensive care unit.
Participants: The admission database and all discharge summaries of each admission to a tertiary paediatric institution’s PIC over a three year period were searched for children aged between 29 days and 15 years with a diagnosis of SE or related diagnoses. The case notes of potential cases of SE were systematically reviewed, and clinical and demographic data extracted using a standard data collection form.
Results: Most children with SE admitted to PIC are aged less than 5 years, male to female ratio 1:1, and most (77%) will have had no previous episodes of SE. Prolonged febrile convulsions, SE related to central nervous system infection, and SE associated with epilepsy occur in similar proportions. Contrary to the Advanced Paediatric Life Support guidelines many children admitted to PIC for SE receive over two doses, or inadequate doses, of benzodiazepine. There is a risk of respiratory depression following administration of over two doses of benzodiazepine (χ2 = 3.4, p = 0.066). Children with SE admitted to PIC who had prehospital emergency treatment are more likely to receive over two doses of benzodiazepines (χ2 = 11.5, p = 0.001), and to subsequently develop respiratory insufficiency (χ2 = 6.2, p = 0.01). Mortality is low. Further study is required to determine the morbidity associated with SE in childhood requiring intensive care.
Conclusions: As the risk of respiratory depression is greater with more than two doses of benzodiazepines, clinicians should not disregard prehospital treatment of SE. As pre-PIC treatment of SE is inadequate in many cases, appropriate audit and modifications of standard guidelines are required.
- AED, antiepileptic drug
- APLS, Advanced Paediatric Life Support
- CNS, central nervous system
- PFC, prolonged febrile convulsion
- PIC, paediatric intensive care
- SE, status epilepticus
