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Analysis of the Delay Components in the Treatment of Status Epilepticus

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Abstract

Background

The factors comprising the delays in management of status epilepticus (SE) have not been systematically studied.

Methods

We studied retrospectively all adult patients (N = 82) diagnosed with SE in Helsinki University Central Hospital emergency room over a 2-year period. We analyzed prehospital, diagnostic, treatment, and treatment response delays based on medical records and quantitatively evaluated data availability and accuracy.

Results

SE manifested mostly without any warning symptoms, but every fifth case presented a pre-status period. Median prehospital delay was 2 h 4 min, including delays in emergency call, ambulance arrival, and patient transportation. Median delay of diagnosing SE was 2 h 10 min. EEG-based diagnosis was significantly delayed compared to clinical diagnosis. Median delay in recording EEG was 22 h 2 min. Median delay of the first medication was 35 min, and those of second- and third-stage medications were 3 h and 2 h 55 min, respectively. We applied stepwise definition for treatment response and counted delays accordingly: total convulsion period 5 h 52 min, Burst-suppression (BS) 17 h 30 min and return of consciousness 47 h 40 min. Median treatment period in intensive care unit was 2.7 days. Mortality over treatment period (median 7.7 days) was 8.5 %. No post-discharge follow-up was performed.

Conclusion

Our study reveals unexpectedly and unacceptably long delays in SE management, stressing the importance of commitment to acknowledged management protocol. Delays in the treatment can and need to be shortened markedly by several strategies discussed in this article.

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Acknowledgments

This study has been financially supported by Hyvinkää Hospital Area Research Grants to L.K. We gratefully acknowledge discussions with professor Reetta Kälviäinen in the course of this study. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

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Authors and Affiliations

  1. Department of Neurology, University of Helsinki, Helsinki, Finland

    Leena Kämppi

  2. Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland

    Harri Mustonen

  3. Department of Neurology, University of Turku, Turku, Finland

    Seppo Soinila

  4. Juhannustie 10-12 F1, 02200, Espoo, Finland

    Leena Kämppi

Authors
  1. Leena Kämppi
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  2. Harri Mustonen
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Correspondence to Leena Kämppi.

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Kämppi, L., Mustonen, H. & Soinila, S. Analysis of the Delay Components in the Treatment of Status Epilepticus. Neurocrit Care 19, 10–18 (2013). https://doi.org/10.1007/s12028-013-9862-x

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