Abstract Details

Title Assessment of Adherence to Status Epilepticus Treatment Guidelines at a Single Institution

Topic Neuro Trauma and Critical Care

Presentation(s) P13 - Poster Session 13 (8:00 AM-9:00 AM)

Poster/Presentation
Number 1-002

Background

SE is a life-threatening emergency that requires prompt diagnosis and treatment. Inappropriate treatment results in prolonged hospitalization and increased mortality. International treatment standards, on which our SE guideline is based, are widely accepted. Adherence to our SE guideline has not been studied at our institution.

Objective

To assess management of status epilepticus (SE) at a tertiary academic hospital, by evaluating timing and dosing of medications given for SE, compared to our institutional SE guideline. Results will reveal practice patterns and guide quality improvement efforts.

Design/Methods This is a single-centered retrospective cohort study. We identified 44 patients >18 years old with SE upon or during admission to UC-San Diego Health hospitals between January 1, 2020 and December 31, 2020. Reviewing medical records, we analyzed adherence to our institutional guidelines’ recommended antiepileptics, dosing and timing. Primary endpoints were: proportion of patients who received benzodiazepine within 5 minutes of seizure detection, and proportion who received antiepileptic within 10 minutes of seizure detection. Secondary endpoints included proportion of patients who received the recommended dose of benzodiazepine, and antiepileptic, respectively. Other data gathered included patient location, disposition, seizure type, and cause of medication delay.

Results

First-line therapy was administered within target time in 45% (20/44) of patients. Second line therapy was administered within target time in 9% (4/44) of patients. Recommended benzodiazepine dose (lorazepam 2-4mg IV or midazolam 5-10mg IM/IV) was administered in 64% (28/44). Recommended antiepileptic dose was administered in 25% (11/44). Location-wise, the largest proportion of non-guideline-adherent doses was given in the Emergency Department. Reasons for nonadherence included: delays in diagnosis, EEG placement, order placement, and medication order to administration.

Conclusions

Our study reveals room for improvement in our institution’s SE guideline execution, including timing and dosing of recommended medications. Targeted quality improvements at the institutional level are needed to increase adherence and possibly improve patient outcomes.

Authors/Disclosures
Steven Yang, DO PRESENTER	Dr. Yang has nothing to disclose.
	No disclosure on file
Victoria L. Wu, MD (UC San Francisco)	Dr. Wu has nothing to disclose.
William Cang	No disclosure on file
Navaz Karanjia, MD (University of California San Diego)	Dr. Karanjia has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Kenneth Sigelman, LLC. Dr. Karanjia has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Norris & Keplinger, LLC.