TY - JOUR
T1 - Association of guideline publication and delays to treatment in pediatric status epilepticus
AU - Sánchez Fernández, Iván
AU - Abend, Nicholas S.
AU - Amengual-Gual, Marta
AU - Anderson, Anne
AU - Arya, Ravindra
AU - Aguilar, Cristina Barcia
AU - Brenton, James Nicholas
AU - Carpenter, Jessica L.
AU - Chapman, Kevin E.
AU - Clark, Justice
AU - Farias-Moeller, Raquel
AU - Gaillard, William D.
AU - Gaínza-Lein, Marina
AU - Glauser, Tracy
AU - Goldstein, Joshua
AU - Goodkin, Howard P.
AU - Guerriero, Réjean M.
AU - Lai, Yi Chen
AU - McDonough, Tiffani
AU - Mikati, Mohamad A.
AU - Morgan, Lindsey A.
AU - Novotny, Edward
AU - Payne, Eric
AU - Peariso, Katrina
AU - Piantino, Juan
AU - Ostendorf, Adam
AU - Sands, Tristan T.
AU - Sannagowdara, Kumar
AU - Tasker, Robert C.
AU - Tchapyjnikov, Dimtry
AU - Topjian, Alexis A.
AU - Vasquez, Alejandra
AU - Wainwright, Mark S.
AU - Wilfong, Angus
AU - Williams, Kowryn
AU - Loddenkemper, Tobias
N1 - Funding Information:
This study and consortium were funded by the Epilepsy Research Fund, the Epilepsy Foundation of America (EF-213583, Targeted Initiative for Health Outcomes), by the American Epilepsy Society/Epilepsy Foundation of America Infrastructure Award, and by the Pediatric Epilepsy Research Foundation.
Funding Information:
I. Sánchez Fernández is funded by the Epilepsy Research Fund and was funded by Fundación Alfonso Martín Escudero and the HHV6 Foundation. N. Abend reports no disclosures relevant to the manuscript. M. Amengual-Gual was funded by Fundación Alfonso Martín Escudero. A. Anderson and R. Arya report no disclosures relevant to the manuscript. C. Barcia Aguilar is funded by Fundación Alfonso Martín Escudero. J.N. Brenton, J. Carpenter, K. Chapman, J. Clark, and R. Farias-Moeller report no disclosures relevant to the manuscript. W. Gaillard is an editor for Epilepsia and Epilepsy Research. M. Gaínza-Lein reports no disclosures relevant to the manuscript. T. Glauser is funded by NIH grants 2U01-NS045911, U10-NS077311, R01-NS053998, R01-NS062756, R01-NS043209, R01-LM011124, and R01-NS065840. He has received consulting fees from Supernus, Sunovion, Eisai, and UCB. He also serves as an expert consultant for the US Department of Justice and has received compensation for work as an expert on medico-legal cases. He receives royalties from a patent license. J. Goldstein, H. Goodkin, R. Guerriero, Y.-C. Lai, T. McDonough, M. Mikati, L. Morgan, E. Novotny, E. Payne, K. Peariso, J. Piantino, A. Ostendorf, T. Sands, K. Sannagowdara, and R. Tasker report no disclosures relevant to the manuscript. D. Tchapyjnikov has received research funding from Children's Miracle Network Hospitals and Duke Forge. He has also received consultation fees from Gerson Lehrman Group, Guidepoint, IQVIA, and bioStrategies Group. A. Topjian and A. Vasquez report no disclosures relevant to the manuscript. M. Wainwright serves as a scientific consultant and on the clinical advisory board for Sage Pharmaceuticals. A. Wilfong receives research funding from Novartis, Eisai, Pfizer, UCB, Acorda, Lundbeck, GW Pharma, Upsher-Smith, and Zogenix and receives publication royalties from Uptodate. K. Williams reports no disclosures relevant to the manuscript. T. Loddenkemper serves on the Council (and as past president) of the American Clinical Neurophysiology Society, as committee chair at the American Epilepsy Society (Investigator Workshop Committee), as founder and consortium principal investigator of the pSERG, as an associate editor for Wyllie's Treatment of Epilepsy, 6th and 7th editions. He is part of pending patent applications to detect, treat, and predict seizures and to diagnose epilepsy. He receives research support from the NIH, Patient-Centered Outcomes Research Institute, Epilepsy Research Fund, the Epilepsy Foundation of America, the Epilepsy Therapy Project, the Pediatric Epilepsy Research Foundation and received research grants from Lundbeck, Eisai, Upsher-Smith, Mallinckrodt, Sage, and Pfizer. He served in the past as a consultant for Zogenix, UCB, Engage, Amzell, Upsher Smith, Eisai, and Sunovion. He performs video EEG long-term and ICU monitoring, and other electrophysiologic studies at Boston Children's Hospital and affiliated hospitals and bills for these procedures, and he evaluates pediatric neurology patients and bills for clinical care. He has received speaker honorariums from national societies including the American Academy of Neurology, American Education Services, and American Clinical Neurophysiology Society, and for grand rounds at various academic centers. T.L. is coinventor of the TriVox Health technology. In the future, it is possible that this technology will be sold commercially. If this were to occur, Dr. Loddenkemper and Boston Children's Hospital might receive financial benefits in the form of compensation. As in all research studies, the hospital has taken steps designed to ensure that this potential for financial gain does not endanger research participants or undercut the validity and integrity of the information learned by this research. His wife, Dr. Karen Stannard, is a pediatric neurologist. She performs video EEG long-term and ICU monitoring, EEGs, and other electrophysiologic studies and bills for these procedures, and she evaluates pediatric neurology patients and bills for clinical care. Go to Neurology.org/N for full disclosures.
Publisher Copyright:
© American Academy of Neurology.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - ObjectiveTo determine whether publication of evidence on delays in time to treatment shortens time to treatment in pediatric refractory convulsive status epilepticus (rSE), we compared time to treatment before (2011-2014) and after (2015-2019) publication of evidence of delays in treatment of rSE in the Pediatric Status Epilepticus Research Group (pSERG) as assessed by patient interviews and record review.MethodsWe performed a retrospective analysis of a prospectively collected dataset from June 2011 to September 2019 on pediatric patients (1 month-21 years of age) with rSE.ResultsWe studied 328 patients (56% male) with median (25th-75th percentile [p25-p75]) age of 3.8 (1.3-9.4) years. There were no differences in the median (p25-p75) time to first benzodiazepine (BZD) (20 [5-52.5] vs 15 [5-38] minutes, p = 0.3919), time to first non-BZD antiseizure medication (68 [34.5-163.5] vs 65 [33-142] minutes, p = 0.7328), and time to first continuous infusion (186 [124.2-571] vs 160 [89.5-495] minutes, p = 0.2236). Among 157 patients with out-of-hospital onset whose time to hospital arrival was available, the proportion who received at least 1 BZD before hospital arrival increased after publication of evidence of delays (41 of 81 [50.6%] vs 57 of 76 [75%], p = 0.0018), and the odds ratio (OR) was also increased in multivariable logistic regression (OR 4.35 [95% confidence interval 1.96-10.3], p = 0.0005).ConclusionPublication of evidence on delays in time to treatment was not associated with improvements in time to treatment of rSE, although it was associated with an increase in the proportion of patients who received at least 1 BZD before hospital arrival.
AB - ObjectiveTo determine whether publication of evidence on delays in time to treatment shortens time to treatment in pediatric refractory convulsive status epilepticus (rSE), we compared time to treatment before (2011-2014) and after (2015-2019) publication of evidence of delays in treatment of rSE in the Pediatric Status Epilepticus Research Group (pSERG) as assessed by patient interviews and record review.MethodsWe performed a retrospective analysis of a prospectively collected dataset from June 2011 to September 2019 on pediatric patients (1 month-21 years of age) with rSE.ResultsWe studied 328 patients (56% male) with median (25th-75th percentile [p25-p75]) age of 3.8 (1.3-9.4) years. There were no differences in the median (p25-p75) time to first benzodiazepine (BZD) (20 [5-52.5] vs 15 [5-38] minutes, p = 0.3919), time to first non-BZD antiseizure medication (68 [34.5-163.5] vs 65 [33-142] minutes, p = 0.7328), and time to first continuous infusion (186 [124.2-571] vs 160 [89.5-495] minutes, p = 0.2236). Among 157 patients with out-of-hospital onset whose time to hospital arrival was available, the proportion who received at least 1 BZD before hospital arrival increased after publication of evidence of delays (41 of 81 [50.6%] vs 57 of 76 [75%], p = 0.0018), and the odds ratio (OR) was also increased in multivariable logistic regression (OR 4.35 [95% confidence interval 1.96-10.3], p = 0.0005).ConclusionPublication of evidence on delays in time to treatment was not associated with improvements in time to treatment of rSE, although it was associated with an increase in the proportion of patients who received at least 1 BZD before hospital arrival.
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U2 - 10.1212/WNL.0000000000010174
DO - 10.1212/WNL.0000000000010174
M3 - Article
C2 - 32611646
AN - SCOPUS:85090171140
SN - 0028-3878
VL - 95
SP - E1222-E1235
JO - Neurology
JF - Neurology
IS - 9
ER -