Guidelines adherence in status epilepticus first steps treatment: factors associated with non-compliance and effect on outcome.

Objective: We investigate adherence to acute-phase treatment guidelines for status epilepticus (SE) in a university and a community hospital, assessing factors influencing compliance and its impact on SE duration and outcomes.

Methods: We retrospectively analyzed two prospective cohorts, including 452 adults with SE (excluding post-anoxic SE). Adherence was defined as administration of a correctly dosed benzodiazepine (BZD) as first-line therapy, followed by a non-sedative antiseizure medication (ASM) as second-line treatment. We examined associations between adherence, clinical and demographic factors, and discharge outcomes.

Results: Only 129/452 (29%) patients received guideline-adherent treatment. A treatment delay > 1 h (p = 0.03) was the only factor significantly associated with non-adherence. Among 323 non-adherent treatment, 283 (89%) received a BZD, but only 66 (28%) at the correct dose. Older age, decreased consciousness, and pre-existing epilepsy influenced BZD treatment patterns. Adherence to treatment sequence did not affect clinical outcomes, but SE duration was significantly shorter in patients treated per guidelines (272 vs. 880 min, p = 0.0003).

Conclusions: Adherence to SE treatment guidelines remains low. Guideline-based treatment shortens SE duration but does not significantly impact discharge outcomes. While age, history of epilepsy and consciousness disorders influence BZD use, the lack of clear predictors of overall adherence suggests possible gaps in guideline awareness among healthcare providers.