Treatment of Patients in Status Epilepticus: A Retrospective Chart Review (P4.224)

Objective: This study’s objective is to determine how the treatment of emergency department patients in status epilepticus adheres to our clinical treatment protocol. Background: Status epilepticus, a neurological emergency, potentially leads to increased risk for morbidity and mortality and neurologic dysfunction. Early identification and treatment are linked to improved outcomes. Despite a hospital-approved protocol for management of status epilepticus, clinical observation suggests that this protocol is not uniformly applied, which has potential for treatment failure. Design/Methods: This retrospective study examined charts from the year 2012. Charts with ICD-9-CM Diagnosis Codes 345.3 or 780 were reviewed. All pediatric and adult patients presenting to the emergency department with active and ongoing convulsive status epilepticus were included. Data was collected to compare each patient’s treatment to the University’s status epilepticus protocol. Results: 44 patients met inclusion criteria. Median time from arrival to first treatment was 15 minutes with 38/44 patients receiving a benzodiazepine. Median time from first to second treatment was 14 minutes with 18/31 patients receiving a benzodiazepine and 10/31 receiving (fos)phenytoin or levetiracetam. Median time from second to third treatment was 15 minutes with 13/21 patients receiving (fos)phenytoin. 41/44 patients were eventually discharged, and 3/44 expired. 15/44 patients received treatment adherent to the protocol; 11/44 received a sequence of medication adherent to the protocol but not at recommended time intervals; and 18/44 received a sequence of medication not adherent to the protocol. Conclusions: Use of the status epilepticus protocol is meant to encourage treatment success, but there is room to improve protocol adherence. 66% of patients, including the three who expired, were not treated in a manner adherent to the protocol. Reducing time to treatment could be a starting point to improve protocol adherence. Limitations of this study include small sample size and retrospective design, which must be considered when interpreting the results. Disclosure: Dr. Tollefson has nothing to disclose. Dr. Saada has nothing to disclose. Dr. Meyers has nothing to disclose. Dr. Liu has received personal compensation for activities with Merke as a consultant.