Evidence map›Paper›PMID 41388551›Full record

ArticleTrials2025

Methodology for the Pediatric Dose Optimization for Seizures in Emergency Medical Services (PediDOSE) study.

Manish I Shah, Kathleen M Adelgais, James M Chamberlain, Henry E Wang, Lindsey A Morgan, James J Riviello, Rana R Said, Joseph E Sullivan, Kimia F Ghaffari, Kathryn M Kothari and 18 more

Abstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in Trials, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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

1 citing paper in PubMed.

  1. 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

28 authors.

Manish I ShahDepartment of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, 94304, USA. mshah5@stanford.edu.ORCID http://orcid.org/0000-0003-0886-8747
Kathleen M AdelgaisSection of Pediatric Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
James M ChamberlainDivision of Emergency Medicine, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
Henry E WangDepartment of Emergency Medicine, The Ohio State University, Columbus, OH, USA.
Lindsey A MorganDivision of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, WA, USA.
James J RivielloDivision of Neurology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Rana R SaidDivision of Neurology, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA.
Joseph E SullivanDepartment of Neurology & Pediatrics, University of California San Francisco, San Francisco, CA, USA.
Kimia F GhaffariDepartment of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Kathryn M KothariDivision of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Mohsen SaidinejadDepartment of Emergency Medicine, Harbor - University of California Los Angeles Medical Center, Torrance, CA, USA.
Robert A LoweColumbus Division of Fire, Columbus, OH, USA.
Raymond L FowlerDivision of Emergency Medical Services, Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX, USA.
Catherine R CountsSection of Emergency Medical Services, Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
Claudia R MorrisDivision of Emergency Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.
Jonathan R StudnekWake County Emergency Medical Services, Raleigh, NC, USA.
Nancy K GloberDepartment of Emergency Medicine and Indianapolis Emergency Medical Services, University of Indiana, Indianapolis, IN, USA.
Caleb E WardDivision of Emergency Medicine, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
Brian M ClemencyDepartment of Emergency Medicine, University at Buffalo, Buffalo, NY, USA.
Nicholas PatrickDepartment of Emergency Medicine, Oregon Health and Sciences University, Portland, OR, USA.
Rachel D MunnDepartment of Emergency Medicine, University of Arizona, Tucson, AZ, USA.
Graham M Brant-ZawadzkiDepartment of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
Christian Martin-GillDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Daniel K NishijimaDepartment of Emergency Medicine, University of California Davis, Sacramento, CA, USA.
Kevin LiDepartment of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA.
Neomi SepulvedaDepartment of Emergency Medicine, McGovern Medical School at the University of Texas Health Sciences Center, Houston, TX, USA.
John M VanBurenDepartment of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Pediatric Emergency Care Applied Research Network (PECARN) PediDOSE Study Investigators

Funding

Pediatric Dose Optimization for Seizures in EMS (PediDOSE)U01NS114042 · NINDS · STANFORD UNIVERSITY · PI Manish Ishwar Shah · 2021 to 2026
$16.3M
HRSA HHS U03MC00001HRSA HHS U03MC00007HRSA HHS U03MC22684HRSA HHS U03MC28844HRSA HHS U03MC33155HRSA HHS U03MC33156HRSA HHS U03MC54727HRSA HHS UJ5MC30824NINDS NIH HHS U01 NS114042NINDS NIH HHS U01NS114042
6 · The paper itself

Abstract

backgroundSeizures are one of the most common reasons for emergency medical services (EMS) activation for children, and current EMS practice results in underdosing and delayed delivery of anti-seizure medication. A prehospital evidence-based guideline recommends using intranasal or intramuscular midazolam as first-line treatment for pediatric seizures. Despite attempts to implement these guidelines, one-third of children having a paramedic-witnessed seizure have ongoing seizures on emergency department (ED) arrival; this may be due to inadequate or delayed midazolam dosing. Replacing the error-prone, sequential calculations with age-based midazolam dosing may be simpler, faster, and more effective without compromising safety. The objective of this manuscript is to describe the methodology of the Pediatric Dose Optimization for Seizures in EMS (PediDOSE) study, a clinical trial designed to compare the effectiveness and safety of an EMS protocol with four age-based categories for midazolam dosing relative to the current weight-based dosing.

methodsWe are conducting a large EMS-based stepped wedge trial in the Pediatric Emergency Care Applied Research Network (PECARN) by implementing midazolam dosing based on four age categories in seizure protocols in EMS systems in 20 cities. We believe that this implementation will stop more seizures before ED arrival without increasing respiratory failure rates. The primary aim of this study is to compare the effectiveness of age-based EMS midazolam dosing compared to the current weight-based dosing on seizure cessation upon ED arrival. The secondary aim is to determine the frequency of respiratory failure in children after the implementation of EMS midazolam dosing based on these age categories.

conclusionIf this study demonstrates that an EMS patient care protocol with age-based midazolam dosing is safe and more effective than current practice, the potential impact of this study is a paradigm shift in the treatment of pediatric seizures that can be easily implemented in EMS systems across the country. Beyond seizures, the concept of age-based dosing may also be applicable to other commonly encountered pediatric prehospital conditions for which medication may be indicated.

Indexed as

AnticonvulsantsEmergency Medical ServicesMidazolamSeizuresAdministration, IntranasalAdolescentAge FactorsChildChild, PreschoolDrug Dosage CalculationsFemaleHumansInfantInjections, IntramuscularMaleMulticenter Studies as TopicAnticonvulsantsMidazolam

Identifiers

PMID41388551
PMCPMC12821847

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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.