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G141 THE MANAGEMENT OF CONVULSIVE STATUS EPILEPTICUS IN A DGH
D. Sekaran1, B. Houston1, R. F. M. Chin2. 1Department of Paediatrics, Luton and Dunstable NHS Trust; 2Department of Neurosciences, Institute of Child Health
Aims: The morbidity and mortality associated with convulsive status epilepticus (CSE) is dependent on the duration of CSE. Thus early and effective treatment of CSE is paramount but there has been a lack of consensus on its emergency management. A working party of the British Paediatric Neurology Association (BPNA) has proposed a national guideline for the management of CSE. This study aims to characterise the emergency treatment of CSE in a district general hospital (DGH) that has adopted the BPNA guideline.
Methods: In a 1 year retrospective study, all children aged between 1 month and 16 years presenting to a DGH with CSE were identified through the DGH’s admission database. The database was searched for the ICD-10 diagnostic codes G40.9 (epilepsy, epileptic, epilepsia, fits, convulsions, and seizure), G41.9 (status epilepticus), R56.0 (febrile convulsion), and R56.8 (idiopathic convulsions). Data on patient demographics, diagnosis, choice of emergency antiepileptic drug (AED), AED dosages, intervals between steps, and complications were collated.
Results: Ten patients with CSE accounting for 15 CSE events were identified (mean age 5.4 years, range 0.3–16, M:F 2:3). In most events (75%) diazepam/lorazepam was administered as first line AED. Half of events requiring second (n = 11) and 20% requiring third line (n = 5) AED were treated with the BPNA guideline’s recommended AED for that step. Overall, only a quarter of patients received the recommended AED dose. The mean interval between AEDs was known in 11 events (step1–step 2 13.5 mins, step 2–step 3 12.5 mins).
Conclusions: CSE is frequently inappropriately treated. Recommended second and third line AEDs are frequently overlooked. Few patients receive the appropriate doses of AEDs. This study highlights the …
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