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Factors Related to Delays in Pre-hospital Management of Status Epilepticus

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Abstract

Introduction

This study was designed to identify factors related to delays in pre-hospital management of status epilepticus (SE).

Methods

This retrospective study includes all adult (>16 years of age) patients (N = 82) diagnosed with established SE in the Helsinki University Central Hospital emergency department (ED) over 2 years. SE was defined as a clinically observed episode fulfilling one of the following criteria: (1) continuous seizure lasting over 30 min; (2) recurring seizures without return of consciousness between seizures; (3) occurrence of more than four seizures within any 1 h. We collected 15 variables related to SE type, patient, and SE episode from the medical records, defined and calculated six pre-hospital delay parameters and analyzed their relations using univariate analysis and multivariate linear regression models.

Results

In the multivariate regression analysis, the focal SE was significantly associated with a long delay from SE onset to initial treatment (p < 0.05), to diagnosis (p < 0.002), and to anesthesia (p < 0.002). Administration of the initial treatment before emergency medical service arrived was significantly associated with long delay of the first alarm (p < 0.02) and arrival at the first ED (p < 0.04). Primary admission to a healthcare unit other than tertiary hospital caused a significant delay in diagnosis (p < 0.008) and anesthesia (p < 0.02). Surprisingly, univariate analysis revealed that if the SE onset occurred in a healthcare unit, the delays from SE onset to first alarm (p < 0.001), to arrival in first ED (p < 0.001), to arrival in tertiary hospital (p < 0.001), to diagnosis (p < 0.02), and to anesthesia (p < 0.01) were significantly longer than in cases in which SE onset occurred at a public place.

Conclusion

We found remarkable inadequacy in recognition of SE both among laity and medical professionals. There is an obvious need for increasing awareness of imminent SE and optimizing the pre-hospital management of established SE. SE should be considered as a medical emergency comparable with stroke and cardiac infarction and be allocated with similar resources in the pre-hospital management.

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Acknowledgments

This study has been financially supported by Epilepsy Research Foundation in Finland to LK. 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.

Conflict of interest

No author of this paper has any conflict of interest to disclose

Author information

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. Soukankaari 2 C 72, 02360, Espoo, Finland

    Leena Kämppi

Authors
  1. Leena Kämppi
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  2. Harri Mustonen
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  3. Seppo Soinila
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Corresponding author

Correspondence to Leena Kämppi.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Online Table 1 Detailed information of the missing data of the 82 consecutive SE patients (DOC 95 kb)

12028_2014_16_MOESM2_ESM.xls

Online Table 2 The complete univariate analysis of the factors related to pre-hospital delays in the management of SE (XLS 60 kb)

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Kämppi, L., Mustonen, H. & Soinila, S. Factors Related to Delays in Pre-hospital Management of Status Epilepticus. Neurocrit Care 22, 93–104 (2015). https://doi.org/10.1007/s12028-014-0016-6

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  • DOI: https://doi.org/10.1007/s12028-014-0016-6

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