ED treatment of child seizures varies

The treatment of Australian children who present to hospital emergency departments with acute seizures varies widely for both second and third line management, a new study finds. However the initial seizure management at the 11 largest paediatric emergency departments in Australia was broadly similar and consistent with Advanced Paediatric Life Support guidelines. Published in the Journal of Paediatrics and Child Health, the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network examined the clinical management of acute seizures, measured by both clinical practice guidelines and reported physician practice. The study found that one of the 11 sites had no seizure clinical practice guidelines, while the rest generally had a policy of first-line use of benzodiazepines based on the Advanced Paediatric Life Support (APLS) algorithms. Phenytoin was most commonly used (89%) as second line treatment, however, only one-third of the physicians would perform rapid sequence intubation (RSI) with thiopentone if the phenytoin failed to work. Those who would not use RSI went on to use other medication strategies, but even if those strategies failed one-third would still not intubate a patient with convulsive status epilepticus (CSE). “There are clearly physicians who will tolerate much longer seizure activity with a higher intubation threshold than others. This is in variation to the APLS algorithm which recommends RSI after phenytoin infusion,” the study’s authors said. They noted that there was also variation in the use of paraldehyde between different physicians. It was recommended by six of the 11 sites and available to 70% of physicians, but only 37% had used it in the preceding 12 months and only 20% said they would use it in a fictional scenario of refractory CSE. Journal of Paediatrics and Child Health; published online....