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Treatment adherence and outcomes in the management of convulsive status epilepticus in the emergency room.Epileptic Disord. 2007 Mar; 9(1):43-50.ED
Abstract
PURPOSE
According to published literature status epilepticus (SE) is associated with 7-39% mortality. Timely management is one variable that potentially influences the outcome. We sought to review the process of acute management of SE at the University of Alberta Hospital and correlate outcome with adherence to a recommended treatment protocol.
METHODS
We identified 86 patients 18 years of age or older who presented with convulsive SE to our emergency room between 2000 and 2004. We defined SE as continuous convulsive activity for 30 or more minutes or >or= 2 convulsions with incomplete recovery in the interim. Information was collected pertaining to etiology, epidemiology, and management. We then reviewed the relationship of the treatment protocol in terms of mortality and morbidity.
RESULTS
Forty five patients were included. There were 18 males and 27 females with a mean age of 45 years; 80% were known to have epilepsy. Sub-therapeutic drug levels were found in the majority 60%; benzodiazepines (diazepam 81% and lorazepam 19%) were the first line agent in 93.3% mostly initiated by paramedics (EMS); 48.9% of patients required intubation and 26.7% required admission to intensive care. Four patients died. Control of convulsive SE was obtained sooner for patients in whom therapy was administered according to the recommended time frame (p <or= 0.02).
CONCLUSION
The presence of strict treatment protocols for SE made readily available for the treating staff could potentially improve the outcome of patients. Despite the lack of standardized treatment protocols among various physicians, most patients are treated according to generally recommended sequence and time frames. Analysis of this data will help devise prospective treatment protocols.
Links
MeSH
Pub Type(s)
Journal Article
Research Support, Non-U.S. Gov't
Language
eng
PubMed ID
17307711
Citation
Muayqil, Taim, et al. "Treatment Adherence and Outcomes in the Management of Convulsive Status Epilepticus in the Emergency Room." Epileptic Disorders : International Epilepsy Journal With Videotape, vol. 9, no. 1, 2007, pp. 43-50.
Muayqil T, Rowe BH, Ahmed SN. Treatment adherence and outcomes in the management of convulsive status epilepticus in the emergency room. Epileptic Disord. 2007;9(1):43-50.
Muayqil, T., Rowe, B. H., & Ahmed, S. N. (2007). Treatment adherence and outcomes in the management of convulsive status epilepticus in the emergency room. Epileptic Disorders : International Epilepsy Journal With Videotape, 9(1), 43-50.
Muayqil T, Rowe BH, Ahmed SN. Treatment Adherence and Outcomes in the Management of Convulsive Status Epilepticus in the Emergency Room. Epileptic Disord. 2007;9(1):43-50. PubMed PMID: 17307711.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - Treatment adherence and outcomes in the management of convulsive status epilepticus in the emergency room.
AU - Muayqil,Taim,
AU - Rowe,Brian H,
AU - Ahmed,S Nizam,
Y1 - 2007/02/15/
PY - 2006/05/14/received
PY - 2006/11/28/accepted
PY - 2007/2/20/pubmed
PY - 2007/5/2/medline
PY - 2007/2/20/entrez
SP - 43
EP - 50
JF - Epileptic disorders : international epilepsy journal with videotape
JO - Epileptic Disord
VL - 9
IS - 1
N2 - PURPOSE: According to published literature status epilepticus (SE) is associated with 7-39% mortality. Timely management is one variable that potentially influences the outcome. We sought to review the process of acute management of SE at the University of Alberta Hospital and correlate outcome with adherence to a recommended treatment protocol. METHODS: We identified 86 patients 18 years of age or older who presented with convulsive SE to our emergency room between 2000 and 2004. We defined SE as continuous convulsive activity for 30 or more minutes or >or= 2 convulsions with incomplete recovery in the interim. Information was collected pertaining to etiology, epidemiology, and management. We then reviewed the relationship of the treatment protocol in terms of mortality and morbidity. RESULTS: Forty five patients were included. There were 18 males and 27 females with a mean age of 45 years; 80% were known to have epilepsy. Sub-therapeutic drug levels were found in the majority 60%; benzodiazepines (diazepam 81% and lorazepam 19%) were the first line agent in 93.3% mostly initiated by paramedics (EMS); 48.9% of patients required intubation and 26.7% required admission to intensive care. Four patients died. Control of convulsive SE was obtained sooner for patients in whom therapy was administered according to the recommended time frame (p <or= 0.02). CONCLUSION: The presence of strict treatment protocols for SE made readily available for the treating staff could potentially improve the outcome of patients. Despite the lack of standardized treatment protocols among various physicians, most patients are treated according to generally recommended sequence and time frames. Analysis of this data will help devise prospective treatment protocols.
SN - 1294-9361
UR - https://www.unboundmedicine.com/medline/citation/17307711/Treatment_adherence_and_outcomes_in_the_management_of_convulsive_status_epilepticus_in_the_emergency_room_
L2 - http://www.jle.com/medline.md?issn=1294-9361&vol=9&iss=1&page=43
DB - PRIME
DP - Unbound Medicine
ER -
