Evidence map›Paper›PMID 32943481›Full record

ArticleNeurology2020

Prehospital midazolam use and outcomes among patients with out-of-hospital status epilepticus.

Elan L Guterman, Joseph K Sanford, John P Betjemann, Li Zhang, James F Burke, Daniel H Lowenstein, S Andrew Josephson, Karl A Sporer

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

25 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Observational
  8. Article
  9. Review
  10. Article
  11. Article
  12. Article
  13. Article
  14. Observational
  15. Article
  16. Review
  17. Article
  18. Review
  19. Review
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Elan L GutermanFrom the Department of Neurology (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Weill Institute for Neurosciences (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Department of Epidemiology & Biostatistics (L.Z.), Department of Medicine (L.Z.), and Department of Emergency Medicine (K.A.S.), University of California, San Francisco; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor. Elan.Guterman@ucsf.edu.
Joseph K SanfordFrom the Department of Neurology (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Weill Institute for Neurosciences (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Department of Epidemiology & Biostatistics (L.Z.), Department of Medicine (L.Z.), and Department of Emergency Medicine (K.A.S.), University of California, San Francisco; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor.
John P BetjemannFrom the Department of Neurology (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Weill Institute for Neurosciences (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Department of Epidemiology & Biostatistics (L.Z.), Department of Medicine (L.Z.), and Department of Emergency Medicine (K.A.S.), University of California, San Francisco; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor.
Li ZhangFrom the Department of Neurology (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Weill Institute for Neurosciences (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Department of Epidemiology & Biostatistics (L.Z.), Department of Medicine (L.Z.), and Department of Emergency Medicine (K.A.S.), University of California, San Francisco; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor.
James F BurkeFrom the Department of Neurology (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Weill Institute for Neurosciences (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Department of Epidemiology & Biostatistics (L.Z.), Department of Medicine (L.Z.), and Department of Emergency Medicine (K.A.S.), University of California, San Francisco; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor.
Daniel H LowensteinFrom the Department of Neurology (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Weill Institute for Neurosciences (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Department of Epidemiology & Biostatistics (L.Z.), Department of Medicine (L.Z.), and Department of Emergency Medicine (K.A.S.), University of California, San Francisco; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor.
S Andrew JosephsonFrom the Department of Neurology (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Weill Institute for Neurosciences (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Department of Epidemiology & Biostatistics (L.Z.), Department of Medicine (L.Z.), and Department of Emergency Medicine (K.A.S.), University of California, San Francisco; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor.
Karl A SporerFrom the Department of Neurology (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Weill Institute for Neurosciences (E.L.G., J.K.S., J.P.B., D.H.L., S.A.J.), Department of Epidemiology & Biostatistics (L.Z.), Department of Medicine (L.Z.), and Department of Emergency Medicine (K.A.S.), University of California, San Francisco; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor.

Funding

Prehospital Management of Status EpilepticusK23NS116128 · NINDS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI GUTERMAN, ELAN · 2020 to 2024
$1.1M
NINDS NIH HHS K23 NS116128
6 · The paper itself

Abstract

objectiveTo examine the use of benzodiazepines and the association between low benzodiazepine dose, breakthrough seizures, and respiratory support in patients with status epilepticus.

methodsIn this cross-sectional analysis of adult patients with status epilepticus treated by an emergency medical services agency from 2013 to 2018, the primary outcome was treatment with a second benzodiazepine dose, an indicator for breakthrough seizure. The secondary outcome was receiving respiratory support. Midazolam was the only benzodiazepine administered.

resultsAmong 2,494 patients with status epilepticus, mean age was 54.0 years and 1,146 (46%) were female. There were 1,537 patients given midazolam at any dose, yielding an administration rate of 62%. No patients received a dose and route consistent with national guidelines. Rescue therapy with a second midazolam dose was required in 282 (18%) patients. Higher midazolam doses were associated with lower odds of rescue therapy (odds ratio [OR], 0.8; 95% confidence interval [CI], 0.7-0.9) and were not associated with increased respiratory support. If anything, higher doses of midazolam were associated with decreased need for respiratory support after adjustment (OR, 0.9; 95% CI, 0.8-1.0).

conclusionsAn overwhelming majority of patients with status epilepticus did not receive evidence-based benzodiazepine treatment. Higher midazolam doses were associated with reduced use of rescue therapy and there was no evidence of respiratory harm, suggesting that benzodiazepines are withheld without clinical benefit. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with status epilepticus, higher doses of midazolam led to a reduced use of rescue therapy without an increased need for ventilatory support.

Indexed as

Emergency Medical ServicesOutcome and Process Assessment, Health CarePractice Guidelines as TopicRespiration, ArtificialAdultBenzodiazepinesCross-Sectional StudiesEvidence-Based MedicineFemaleGuideline AdherenceHumansHypnotics and SedativesMaleMidazolamMiddle AgedStatus EpilepticusBenzodiazepinesHypnotics and SedativesMidazolam

Identifiers

PMID32943481
PMCPMC7836670

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.