The essence of the first 2.5 h in the treatment of generalized convulsive status epilepticus

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Kämppi , L , Mustonen , H , Kotisaari , K & Soinila , S 2018 , ' The essence of the first 2.5 h in the treatment of generalized convulsive status epilepticus ' , Seizure - European Journal of Epilepsy , vol. 55 , pp. 9-16 . https://doi.org/10.1016/j.seizure.2017.12.007

Title: The essence of the first 2.5 h in the treatment of generalized convulsive status epilepticus
Author: Kämppi, Leena; Mustonen, Harri; Kotisaari, Kaisa; Soinila, Seppo
Contributor: University of Helsinki, Neurologian yksikkö
University of Helsinki, Clinicum
University of Helsinki, Neurologian yksikkö
Date: 2018-02
Language: eng
Number of pages: 8
Belongs to series: Seizure - European Journal of Epilepsy
ISSN: 1059-1311
URI: http://hdl.handle.net/10138/302055
Abstract: Purpose: This study was designed to find realistic cut-offs of the delays predicting outcome after generalized convulsive status epilepticus (GCSE) and serving protocol streamlining of GCSE patients. Method: This retrospective study includes all consecutive adult (>16 years) patients (N = 70) diagnosed with GCSE in Helsinki University Central Hospital emergency department over 2 years. We defined ten specific delay parameters in the management of GCSE and determined functional outcome and mortality at hospital discharge. Functional outcome was assessed with Glasgow Outcome Scale (GOS1-3 for poor outcome, GOS > 3 for good outcome) and also defined as condition relative to baseline (worse-than baseline vs. baseline). Univariate and multivariate regression models were used to analyze the relations between delays and outcome. Delay cut-offs predicting outcome were determined using ROC-Curves. Results: In univariate analysis long onset-to-tertiary-hospital time (p = 0.034) was a significant risk factor for worse-than-baseline condition. Long delays in onset-to-diagnosis (p = 0.032), onset-to-second-stage medication (p = 0.023), onset-to-consciousness (p = 0.027) and long total-anesthesia-time (0 = 0.043) were risk factors for low GOS score (1-3). Short delay in onset-to-initial-treatment (p = 0.047), long onset-to-anesthesia (p = 0.003) and onset-to-consciousness (p = 0.008) times were risk factors for in hospital mortality. Multivariate analysis showed no significant factors. Cut-offs for increased risk of poor outcome were onset-to-diagnosis 2.4 h (p = 0.011), onset-to-second stage-medication 2.5 h (p = 0.001), onset-to-consciousness 41.5 h (p = 0.009) times and total-anesthesia time 45.5 h (p = 0.003). The delay over 2.1 h in onset-to-tertiary-hospital time increased the risk of worse than-baseline condition (p = 0.028). Conclusions: GCSE treatment is a dynamic process, where every delay component needs to be optimized. We suggest that GCSE patients should be handled with high priority and transported directly to hospital ED with neurological expertise. Critical steps in the treatment, such as diagnosing GCSE and starting progressive antiepileptic medication on stages 1 through 3, if needed, should be accomplished within 2.5 h. (C) 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Subject: Status epilepticus
Seizure
Protocol
Pre-hospital
Diagnosis
REFRACTORY STATUS EPILEPTICUS
BARBITURATE ANESTHETIC TREATMENT
STROKE THROMBOLYSIS
MANAGEMENT
PROGNOSIS
MORTALITY
ADULTS
DELAY
PREDICTORS
GUIDELINES
3112 Neurosciences
3124 Neurology and psychiatry
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