Benzodiazepine administration patterns before escalation to second‐line medications in pediatric refractory convulsive status epilepticus

Objective This study was undertaken to evaluate benzodiazepine (BZD) administration patterns before transitioning to non‐BZD antiseizure medication (ASM) in pediatric patients with refractory convulsive status epilepticus (rSE). Methods This retrospective multicenter study in the United States and C...

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Published in:Epilepsia (Copenhagen) 2021-11, Vol.62 (11), p.2766-2777
Main Authors: Sheehan, Theodore, Amengual‐Gual, Marta, Vasquez, Alejandra, Abend, Nicholas S., Anderson, Anne, Appavu, Brian, Arya, Ravindra, Barcia Aguilar, Cristina, Brenton, J. Nicholas, Carpenter, Jessica L., Chapman, Kevin E., Clark, Justice, Farias‐Moeller, Raquel, Gaillard, William D., Gaínza‐Lein, Marina, Glauser, Tracy A., Goldstein, Joshua L., Goodkin, Howard P., Guerriero, Réjean M., Huh, Linda, Jackson, Michele, Kapur, Kush, Kahoud, Robert, Lai, Yi‐Chen, McDonough, Tiffani L., Mikati, Mohamad A., Morgan, Lindsey A., Novotny, Edward J., Ostendorf, Adam P., Payne, Eric T., Peariso, Katrina, Piantino, Juan, Reece, Latania, Riviello, James J., Sands, Tristan T., Sannagowdara, Kumar, Shellhaas, Renee, Smith, Garnett, Tasker, Robert C., Tchapyjnikov, Dmitry, Topjian, Alexis A., Wainwright, Mark S., Wilfong, Angus, Williams, Korwyn, Zhang, Bo, Loddenkemper, Tobias
Format: Article
Language:English
Subjects:
Anticonvulsants - therapeutic use
benzodiazepine
Benzodiazepines
Benzodiazepines - therapeutic use
Child
Child, Preschool
Drug Resistant Epilepsy - drug therapy
Epilepsy
Full‐length Original Research
Humans
Patients
pediatric
Pediatrics
Retrospective Studies
Risk factors
seizure
Seizures - drug therapy
status epilepticus
Status Epilepticus - drug therapy
treatment
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Summary:Objective This study was undertaken to evaluate benzodiazepine (BZD) administration patterns before transitioning to non‐BZD antiseizure medication (ASM) in pediatric patients with refractory convulsive status epilepticus (rSE). Methods This retrospective multicenter study in the United States and Canada used prospectively collected observational data from children admitted with rSE between 2011 and 2020. Outcome variables were the number of BZDs given before the first non‐BZD ASM, and the number of BZDs administered after 30 and 45 min from seizure onset and before escalating to non‐BZD ASM. Results We included 293 patients with a median (interquartile range) age of 3.8 (1.3–9.3) years. Thirty‐six percent received more than two BZDs before escalating, and the later the treatment initiation was after seizure onset, the less likely patients were to receive multiple BZD doses before transitioning (incidence rate ratio [IRR] = .998, 95% confidence interval [CI] = .997–.999 per minute, p = .01). Patients received BZDs beyond 30 and 45 min in 57.3% and 44.0% of cases, respectively. Patients with out‐of‐hospital seizure onset were more likely to receive more doses of BZDs beyond 30 min (IRR = 2.43, 95% CI = 1.73–3.46, p 
ISSN:0013-9580
1528-1167
DOI:10.1111/epi.17043