Background and Aims In september 2011 results of an audit on the acute management of SE in referring hospitals highlighting safety and feasibility of extubation in some children avoiding transfer to PICU were presented. We re-audited practice to determine whether education had an effect on local extubation rates.
Methods Audit of referral forms with a diagnosis of “seizures”, “SE”, “fit/fitting,” “convulsion” and “epilepsy” from 1 September 2011 till 1 April 2012. Review of discharge summaries and notes of patients transferred to PICU.
Results 56 referrals for seizures (48 patients) in the 7 month period. At referral, 49 patients were intubated. 30 of 49 intubated patients were transferred to PICU, 19 extubated locally. 15 of 30 retrieved and 6 of 15 extubated patients had epilepsy.
Reasons for not attempting extubation included: ongoing seizures (2), Petechial rash (2), transfer for expert opinion (1), previous failed extubation (2) and refusal to assess (2).
All patients managed locally extubated within 6 hours. Extubation in PICU was after < 6 (4), < 12 (7), < 24 (11) or >24 hours (3), data unavailable in 4.
1 patient was re-intubated locally because of further seizures.
Conclusions We found an increase in safe extubations: 18.9% prior and 38.7% after. This re-audit indicates that outreach education by PICU retrieval teams can achieve change in practice. It reconfirms that patients with SE transferred to PICU have a short duration of intubation. Refusal to assess feasibility of extubation by the local hospital can no longer be considered good medical practice.
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