Reader Response: Association of Guideline Publication and Delays to Treatment in Pediatric Status Epilepticus

Sánchez Fernández et al.1 reported that the publication of evidence on delays in treatment of pediatric refractory convulsive status epilepticus (rSE) was not associated with improvement in time to treatment of rSE (TTTSE). They propose interventions to reduce TTTSE. We would like to share a successful model that we implemented. In 2013, we identified delays in TTTSE in our institution.2 We saw no improvement in TTTSE after a dual intervention consisting of educational programs for healthcare professionals and the development of an electronic SE order set.3 This prompted us to develop an SE alert system that was modeled after our “code stroke” protocol.4 When an inpatient is suspected to have SE, the SE alert is activated by calling an operator who simultaneously pages the neurology and pharmacy house staff, the rapid response team, and the manager responsible for bed assignment. Use of this alert system led to considerable reduction in time to administration of second-line antiseizure medications (22.21 ± 3.44 minutes) compared with standard care (58.30 ± 6.72 minutes; p < 0.0001).4 Because many hospitals have alert protocols for management of acute stroke, SE alert systems could be replicated with local resources to facilitate timely management and coordinated care of SE in adults and children.

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