Outcomes of deviation from treatment guidelines in status epilepticus: A systematic review

Uppal, Preena; Cardamone, Michael; Lawson, John A.

doi:10.1016/j.seizure.2018.04.005

Cited by 40 publications

(40 citation statements)

References 34 publications

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“…Inadequate dosing and overuse of benzodiazepines leading to respiratory failure and intubation, and a delay to second-line therapy have previously been highlighted. 11 Second-line treatment of established SE was essentially evenly split evenly between phenytoin and levetiracetam in this survey, which reflects the current literature, with the trend towards the newer and easier to us levetiracetam, which has been recently shown to be non-inferior to phenytoin in both children and adults. [23][24][25] Levetiracetam treatment failure in the past may have been attributable to significant underdosing.…”

Section: Management Of Sesupporting

confidence: 74%

“…10 A recent systematic review from Australian authors concluded that there are often deviations from published within hospital guidelines of SE, and that non-adherence to these guidelines is associated with worse outcomes. 11 Significantly improved outcomes in seizure cessation, necessity for ICU admission and length of stay, have been demonstrated with adherence to treatment protocols. 12 While neurologists and epileptologists may not always be involved in the initial management of CSE, their input is invariably needed in NCSE; thus, their involvement in the development of treatment guidelines and use of cEEG is required.…”

Section: Introductionmentioning

confidence: 99%

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Continuous EEG use and status epilepticus treatment in Australasia: a practice survey of Australian and New Zealand epileptologists

et al. 2020

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ObjectiveContinuous electroencephalography (cEEG) is increasingly used to detect non-convulsive seizures in critically ill patients but is not widely practised in Australasia. Use of cEEG is also influencing the management of status epilepticus (SE), which is rapidly evolving. We aimed to survey Australian and New Zealand cEEG use and current treatment of SEMethodsA web-based survey was distributed to Epilepsy Society of Australia (ESA) members, between October and November 2019. Adult and paediatric neurologists/epileptologists with ESA membership involved in clinical epilepsy care and cEEG interpretation were invited to participate.ResultsThirty-five paediatric/adult epileptologists completed the survey, 51% with over 10 years of consultant experience. cEEG was always available for only 31% of respondents, with the majority having no or only ad hoc access to cEEG. Lack of funding (74%) and personnel (71%) were the most common barriers to performing cEEG. Although experience with SE was common, responses varied regarding treatment approaches for both convulsive and non-convulsive SE. Escalation to anaesthetic treatment of convulsive SE tended to occur later than international guideline recommendations. There was general agreement that formal training in cEEG and national guidelines for SE/cEEG were needed.ConclusionscEEG availability remains limited in Australia, with lack of funding and resourcing being key commonly identified barriers. Current opinions on the use of cEEG and treatment of SE vary reflecting the complexity of management and a rapidly evolving field. An Australian-based guideline for the management of SE, including the role of cEEG is recommended.

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Section: Management Of Sesupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Continuous EEG use and status epilepticus treatment in Australasia: a practice survey of Australian and New Zealand epileptologists

et al. 2020

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“…Our compliance rate of 3% compared with the published literature, where adherence rates to guidelines ranged from 14.3% to 66% . A recent systematic review shows poor outcomes, including increased intubation, following deviation of guidelines …”

Section: Discussionmentioning

confidence: 99%

“…9 A recent systematic review shows poor outcomes, including increased intubation, following deviation of guidelines. 10 Age and aetiology have been shown to be the main predictive factors for SE outcome. 11,12 However, there are limited data regarding adherence to guidelines and the outcomes of SE.…”

Section: Compliance To Management Guidelinesmentioning

confidence: 99%

Management of status epilepticus in children prior to medical retrieval: Deviations from the guidelines

Uppal

Cardamone

Webber

et al. 2019

J Paediatrics Child Health

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Aim To evaluate the influence of adherence to treatment guidelines on outcomes in children presenting with status epilepticus (SE) using the Newborn and Paediatric Emergency Transport Service, New South Wales prospective registry. Methods We reviewed the treatment of children with SE, transported by the Newborn And Paediatric Emergency Transport Service to a tertiary paediatric hospital, over 1 year. We evaluated variation in management from the New South Wales clinical practice guideline. Results There was excessive administration of benzodiazepines (BZD) and a delay in administration of appropriate second‐line treatment of status (median 45 min). There was excessive use of BZD, with five or more doses of BZD associated with significantly higher odds for intubation. Conclusion There is considerable scope to improve clinician compliance with the SE clinical practice guidelines.

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“…Previous studies have evaluated the association between adherence to status epilepticus guidelines and clinical outcomes, with controversial results. 38,39 Standardization of short and long-term clinical outcomes may guide our understanding on the importance of guideline adherence in the treatment of status epilepticus and the need of strategies to improve adherence. Second, although we have examined our pathways during a contemporary time period (between August 2016 and August 2017), these pathways are constantly evolving.…”

Section: Aed Dosesmentioning

confidence: 99%

Hospital Emergency Treatment of Convulsive Status Epilepticus: Comparison of Pathways From Ten Pediatric Research Centers

Vasquez

Gaínza‐Lein

Fernández

et al. 2018

Pediatric Neurology

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Outcomes of deviation from treatment guidelines in status epilepticus: A systematic review

Abstract: This review provides preliminary evidence that non-adherence to SE guidelines negatively impacts on patient outcomes. Appropriate and timely treatment is imperative for rapid seizure termination and improving outcomes.

Cited by 40 publications

References 34 publications

Continuous EEG use and status epilepticus treatment in Australasia: a practice survey of Australian and New Zealand epileptologists

Continuous EEG use and status epilepticus treatment in Australasia: a practice survey of Australian and New Zealand epileptologists

Management of status epilepticus in children prior to medical retrieval: Deviations from the guidelines

Hospital Emergency Treatment of Convulsive Status Epilepticus: Comparison of Pathways From Ten Pediatric Research Centers

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