Evidence map›Paper›PMID 35931608›Full record

ArticleAnnals of emergency medicine2022

Real-World Midazolam Use and Outcomes With Out-of-Hospital Treatment of Status Epilepticus in the United States.

Elan L Guterman, Karl A Sporer, Thomas B Newman, Remle P Crowe, Daniel H Lowenstein, S Andrew Josephson, John P Betjemann, James F Burke

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of emergency medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
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

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Observational
  6. Review
  7. Article
  8. Article
  9. Article
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

8 authors at 3 institutions in 1 country.

Elan L GutermanDepartment of Neurology, University of California, San Francisco, CA; Weill Institute for Neurosciences, University of California, San Francisco, CA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA. Electronic address: Elan.Guterman@ucsf.edu.
Karl A SporerDepartment of Emergency Medicine, University of California, San Francisco, CA.
Thomas B NewmanDepartment of Epidemiology & Biostatistics, University of California, San Francisco, CA.
Remle P CroweESO, Inc. Kaiser Permanente, Northern California, San Francisco, CA.
Daniel H LowensteinDepartment of Neurology, University of California, San Francisco, CA; Weill Institute for Neurosciences, University of California, San Francisco, CA.
S Andrew JosephsonDepartment of Neurology, University of California, San Francisco, CA; Weill Institute for Neurosciences, University of California, San Francisco, CA.
John P BetjemannDepartment of Neurology, Kaiser Permanente, Northern California, San Francisco, CA.
James F BurkeDepartment of Neurology, Ohio State Wexner Medical Center, Columbus, OH; Department of Neurology, University of Michigan, Ann Arbor, MI.
University of California, San Francisco · USKaiser Permanente · USUniversity of Michigan–Ann Arbor · US

Funding

Established Status Epilepticus Treatment Trial (ESETT)U01NS088034 · NINDS · UNIVERSITY OF VIRGINIA · PI CHAMBERLAIN, JAMES, KAPUR, JAIDEEP · 2014 to 2018
$16.3M
The Jackson Laboratory Center for Precision Genetics: From New Models to Novel TherapeuticsU54OD020351 · OD · JACKSON LABORATORY · PI KORSTANJE, RONNY · 2015 to 2019
$10.2M
The Care Ecosystem: Navigating patients and caregivers through stages of dementia careR01AG056715 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI POSSIN, KATHERINE LAUREL · 2017 to 2021
$6.0M
Understanding Implications of End-of-life Preferences to Optimize Advance Care Planning Among Older AmericansR01AG059733 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI BURKE, JAMES FRANCIS, SKOLARUS, LESLI ELIZABETH · 2018 to 2022
$3.1M
Reducing Racial Disparities in Post-Stroke Disability in the ElderlyR01MD008879 · NIMHD · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI BURKE, JAMES FRANCIS, SKOLARUS, LESLI ELIZABETH · 2014 to 2018
$1.9M
Prehospital Management of Status EpilepticusK23NS116128 · NINDS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI GUTERMAN, ELAN · 2020 to 2024
$1.1M
NIA NIH HHS R01 AG056715NIA NIH HHS R01 AG059733NIH HHS U54 OD020351NIMHD NIH HHS R01 MD008879NINDS NIH HHS K23 NS116128NINDS NIH HHS U01 NS088034
6 · The paper itself

Abstract

STUDY

objectiveGuidelines recommend 10-mg intramuscular midazolam as the first-line treatment option for status epilepticus. However, in real-world practice, it is frequently administered intranasally or intravenously and is dosed lower. Therefore, we used conventional and instrumental variable approaches to examine the effectiveness of midazolam in a national out-of-hospital cohort.

methodsThis retrospective cohort study of adults with status epilepticus used the ESO Data Collaborative research dataset (January 1, 2019, to December 31, 2019). The exposures were the route and dose of midazolam. We performed hierarchical logistic regression and 2-stage least squares regression using agency treatment patterns as an instrument to examine our outcomes, rescue therapy, and ventilatory support.

resultsThere were 7,634 out-of-hospital encounters from 657 EMS agencies. Midazolam was administered intranasally in 20%, intravenously in 46%, and intramuscularly in 35% of the encounters. Compared with intramuscular administration, intranasal midazolam increased (risk difference [RD], 6.5%; 95% confidence interval [CI], 2.4% to 10.5%) and intravenous midazolam decreased (RD, -11.1%; 95% CI, -14.7% to -7.5%) the risk of rescue therapy. The differences in ventilatory support were not statistically significant (intranasal RD, -1.5%; 95% CI, -3.2% to 0.3%; intravenous RD, -0.3%; 95% CI, -1.9% to 1.2%). Higher doses were associated with a lower risk of rescue therapy (RD, -2.6%; 95% CI, -3.3% to -1.9%) and increased ventilatory support (RD, 0.4%; 95% CI, 0.1% to 0.7%). The instrumental variable analysis yielded similar results, except that dose was not associated with ventilatory support.

conclusionThe route and dose of midazolam affect clinical outcomes. Compared with intramuscular administration, intranasal administration may be less effective and intravenous administration more effective in terminating status epilepticus, although the differences between these and previous results may reflect the nature of real-world data as opposed to randomized data.

Indexed as

MidazolamStatus EpilepticusAdministration, IntranasalAdultAnticonvulsantsHospitalsHumansRetrospective StudiesUnited StatesAnticonvulsantsMidazolam

Identifiers

PMID35931608
PMCPMC9930617
OpenAlexW4289526016

What OpenQuestion holds

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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.