Seizure emergency code strategy: Improving treatment times and hospital outcomes for patients with urgent epileptic seizures.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Epileptic Disorders Pub Date : 2024-08-20 DOI:10.1002/epd2.20273

Camilo Espinosa-Jovel, Sandra Riveros, Natalia Valencia-Enciso, Alberto Velásquez, Juan Vergara-Palma, Fidel Sobrino-Mejía

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引用次数: 0

Abstract

Objective: Timely treatment is one of the most relevant prognostic factors in patients with urgent epileptic seizures. Despite the available evidence, treatment times remain suboptimal. The aim of this study was to demonstrate the impact of the "seizure code" in an emergency department, focusing on both treatment times and hospital outcomes of patients with urgent epileptic seizures.

Methods: An ambispective cohort study was conducted in the emergency department of a public hospital in Bogotá, Colombia. Treatment times and hospital outcomes were evaluated both before and after the implementation of the seizure code.

Results: A total of 336 patients were included (94 in the pre-seizure code period and 242 in the post-seizure code period). Both cohorts were comparable in terms of clinical and demographic baseline characteristics. After the implementation of the seizure code, in-hospital treatment times improved among patients with status epilepticus and seizure cluster. For the group of patients with status epilepticus, the time from arrival to the first benzodiazepine decreased from a median of 100.5 min (IQR: 43-152.5) to a median of 20 min (IQR: 10-45) (p = .0063), and the time from arrival to the first non-benzodiazepine antiseizure medication decreased from a median of 155 min (IQR: 49-194) to a median of 39 min (IQR: 25-57) (p = .0071). For the group of patients with seizure cluster, the time from arrival to the first non-benzodiazepine antiseizure medication decreased from a median of 296 min (IQR: 112.5-409) to a median of 72 min (IQR: 46-111) (p < .001). The seizure code significantly decreased the risk of inappropriate benzodiazepine use (p = .0087), in-hospital seizure recurrence (p < .001), in-hospital mortality (p = .0074), and prolonged hospitalizations (more than 48 h) (p = .0475).

Significance: The seizure code shortens the time to treatment, reduces the length of hospital stay, decreases the risk of inappropriate benzodiazepine use, and lowers both the in-hospital seizure recurrence and in-hospital mortality among patients with urgent epileptic seizures.

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癫痫发作紧急代码策略：改善癫痫紧急发作患者的治疗时间和住院效果。

目的：及时治疗是癫痫紧急发作患者最重要的预后因素之一。尽管已有证据表明，治疗时间仍然不够理想。本研究旨在证明 "癫痫发作代码 "对急诊科的影响，重点关注紧急癫痫发作患者的治疗时间和住院预后：在哥伦比亚波哥大一家公立医院的急诊科开展了一项前瞻性队列研究。方法：在哥伦比亚波哥大一家公立医院的急诊科开展了一项前瞻性队列研究，对实施癫痫发作代码前后的治疗时间和住院效果进行了评估：研究共纳入 336 名患者（其中 94 人在癫痫发作代码实施前，242 人在癫痫发作代码实施后）。两组患者在临床和人口统计学基线特征方面具有可比性。实施癫痫发作代码后，癫痫状态和癫痫群集患者的院内治疗时间有所缩短。对于癫痫状态组患者，从到达医院到首次使用苯二氮卓类药物的时间从中位数 100.5 分钟（IQR：43-152.5）缩短至中位数 20 分钟（IQR：10-45）（p = .0063），从到达医院到首次使用非苯二氮卓类抗癫痫药物的时间从中位数 155 分钟（IQR：49-194）缩短至中位数 39 分钟（IQR：25-57）（p = .0071）。对于癫痫群集患者组，从到达医院到首次使用非苯二氮卓抗癫痫药物的时间从中位数 296 分钟（IQR：112.5-409）缩短至中位数 72 分钟（IQR：46-111）（p 意义重大：癫痫发作代码缩短了治疗时间，缩短了住院时间，降低了不适当使用苯二氮卓类药物的风险，降低了紧急癫痫发作患者的院内癫痫复发率和院内死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epileptic Disorders 医学-临床神经学

CiteScore

4.10

自引率

8.70%

发文量

138

审稿时长

6-12 weeks

期刊介绍： Epileptic Disorders is the leading forum where all experts and medical studentswho wish to improve their understanding of epilepsy and related disorders can share practical experiences surrounding diagnosis and care, natural history, and management of seizures. Epileptic Disorders is the official E-journal of the International League Against Epilepsy for educational communication. As the journal celebrates its 20th anniversary, it will now be available only as an online version. Its mission is to create educational links between epileptologists and other health professionals in clinical practice and scientists or physicians in research-based institutions. This change is accompanied by an increase in the number of issues per year, from 4 to 6, to ensure regular diffusion of recently published material (high quality Review and Seminar in Epileptology papers; Original Research articles or Case reports of educational value; MultiMedia Teaching Material), to serve the global medical community that cares for those affected by epilepsy.