Evidence map›Paper›PMID 34418087›Full record

Observational studyEpilepsia2021

Benzodiazepine administration patterns before escalation to second-line medications in pediatric refractory convulsive status epilepticus.

Theodore Sheehan, Marta Amengual-Gual, Alejandra Vasquez, Nicholas S Abend, Anne Anderson, Brian Appavu, Ravindra Arya, Cristina Barcia Aguilar, J Nicholas Brenton, Jessica L Carpenter and 37 more

Open access · greenAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Epilepsia, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
1.5field-weighted citation impact, top 18% of its field
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

10 citing papers in PubMed, 14 citations in OpenAlex.

  1. Trial
  2. Article
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  9. Review
  10. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

47 authors at 20 institutions in 4 countries.

Theodore SheehanDivision of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0002-8059-9388
Marta Amengual-GualDivision of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0002-6887-3495
Alejandra VasquezDivision of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Nicholas S AbendDivision of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.ORCID 0000-0001-6166-2663
Anne AndersonSection of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Brian AppavuDepartment of Pediatrics, University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA.
Ravindra AryaDivision of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.ORCID 0000-0003-0873-9718
Cristina Barcia AguilarDivision of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0002-4719-6683
J Nicholas BrentonDepartment of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, Virginia, USA.
Jessica L CarpenterCenter for Neuroscience, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Kevin E ChapmanDepartments of Pediatrics and Neurology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.
Justice ClarkDivision of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Raquel Farias-MoellerDepartment of Neurology, Division of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.ORCID 0000-0001-8717-7703
William D GaillardCenter for Neuroscience, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.ORCID 0000-0001-5709-0033
Marina Gaínza-LeinDivision of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0001-9175-9458
Tracy A GlauserDivision of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.
Joshua L GoldsteinRuth D. & Ken M. Davee Pediatric Neurocritical Care Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Howard P GoodkinDepartment of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, Virginia, USA.
Réjean M GuerrieroDivision of Pediatric and Developmental Neurology, Departments of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.ORCID 0000-0001-7788-6661
Linda HuhDivision of Neurology, Department of Paediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada.
Michele JacksonDivision of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Kush KapurDepartment of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Robert KahoudDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA.
Yi-Chen LaiSection of Pediatric Critical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.ORCID 0000-0002-9450-5506
Tiffani L McDonoughDivision of Child Neurology, Department of Neurology, Columbia University Medical Center, Columbia University, New York, New York, USA.
Mohamad A MikatiDivision of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, North Carolina, USA.ORCID 0000-0003-0363-8715
Lindsey A MorganDepartments of Neurology and Pediatrics, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA.ORCID 0000-0003-2206-5561
Edward J NovotnyDepartments of Neurology and Pediatrics, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA.ORCID 0000-0001-9726-0447
Adam P OstendorfDepartment of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
Eric T PayneDivision of Neurology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.
Katrina PearisoDivision of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.
Juan PiantinoDivision of Neurology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA.
Latania ReeceDivision of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
James J RivielloSection of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Tristan T SandsDivision of Child Neurology, Department of Neurology, Columbia University Medical Center, Columbia University, New York, New York, USA.ORCID 0000-0001-7285-1195
Kumar SannagowdaraDepartment of Neurology, Division of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Renee ShellhaasDepartment of Pediatrics, Division of Pediatric Neurology, University of Michigan, Ann Arbor, Michigan, USA.ORCID 0000-0002-3175-3908
Garnett SmithDepartment of Pediatrics, Division of Pediatric Neurology, University of Michigan, Ann Arbor, Michigan, USA.
Robert C TaskerDivision of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Dmitry TchapyjnikovDivision of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, North Carolina, USA.
Alexis A TopjianCritical Care and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Mark S WainwrightDepartments of Neurology and Pediatrics, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA.
Angus WilfongDepartment of Pediatrics, University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA.
Korwyn WilliamsDepartment of Pediatrics, University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA.
Bo ZhangDepartment of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Tobias LoddenkemperDivision of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0003-2074-0674
Pediatric Status Epilepticus Research Group
Boston Children's Hospital · USBarrow Neurological Institute · USBaylor College of Medicine · USCincinnati Children's Hospital Medical Center · USSeattle Children's Hospital · USChildren's Hospital of Philadelphia · USChildren's Hospital of Wisconsin · USChildren's National · USColumbia University Irving Medical Center · USUniversity of Michigan · USUniversity of Virginia Health System · USAlberta Children's Hospital · CAChildren's Hospital Colorado · USDuke Medical Center · USKalispell Regional Medical Center · USMayo Clinic · USNationwide Children's Hospital · USNorthwestern University · USOregon Health & Science University · USUniversity of British Columbia · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThis study was undertaken to evaluate benzodiazepine (BZD) administration patterns before transitioning to non-BZD antiseizure medication (ASM) in pediatric patients with refractory convulsive status epilepticus (rSE).

methodsThis retrospective multicenter study in the United States and Canada used prospectively collected observational data from children admitted with rSE between 2011 and 2020. Outcome variables were the number of BZDs given before the first non-BZD ASM, and the number of BZDs administered after 30 and 45 min from seizure onset and before escalating to non-BZD ASM.

resultsWe included 293 patients with a median (interquartile range) age of 3.8 (1.3-9.3) years. Thirty-six percent received more than two BZDs before escalating, and the later the treatment initiation was after seizure onset, the less likely patients were to receive multiple BZD doses before transitioning (incidence rate ratio [IRR] = .998, 95% confidence interval [CI] = .997-.999 per minute, p = .01). Patients received BZDs beyond 30 and 45 min in 57.3% and 44.0% of cases, respectively. Patients with out-of-hospital seizure onset were more likely to receive more doses of BZDs beyond 30 min (IRR = 2.43, 95% CI = 1.73-3.46, p < .0001) and beyond 45 min (IRR = 3.75, 95% CI = 2.40-6.03, p < .0001) compared to patients with in-hospital seizure onset. Intermittent SE was a risk factor for more BZDs administered beyond 45 min compared to continuous SE (IRR = 1.44, 95% CI = 1.01-2.06, p = .04). Forty-seven percent of patients (n = 94) with out-of-hospital onset did not receive treatment before hospital arrival. Among patients with out-of-hospital onset who received at least two BZDs before hospital arrival (n = 54), 48.1% received additional BZDs at hospital arrival. SIGNIFICANCE: Failure to escalate from BZDs to non-BZD ASMs occurs mainly in out-of-hospital rSE onset. Delays in the implementation of medical guidelines may be reduced by initiating treatment before hospital arrival and facilitating a transition to non-BZD ASMs after two BZD doses during handoffs between prehospital and in-hospital settings.

Indexed as

Drug Resistant EpilepsyStatus EpilepticusAnticonvulsantsBenzodiazepinesChildChild, PreschoolHumansRetrospective StudiesSeizuresAnticonvulsantsBenzodiazepinesbenzodiazepineepilepsypediatricseizurestatus epilepticustreatment

Identifiers

PMID34418087
PMCPMC9292193
OpenAlexW3194974278

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LicenceCC BY-NC
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Registered trials

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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.