C.5 Highlighting a novel, stepwise pathway for the in-hospital management of children with acutely worsening dystonia

Abstract

Background: Dystonia is common in children with acquired and inherited neurological disorders. Status dystonicus (SD) is the most severe form of dystonia that can lead to life-threatening complications if not treated promptly. We identified a local provider knowledge gap in the acute management of dystonia, leading to uncertainty and delays in care. To our knowledge, no in-hospital clinical pathway exists for the ward-based management of acute dystonia. We hypothesized that a stepwise clinical pathway would standardize and improve comfort in managing hyperacute dystonia. Methods: We formed a multidisciplinary working group and developed a pathway based on literature review and expert consensus. Aims of the pathway included: reducing delays in recognition and treatment of acute dystonia, limiting variation in management, and decreasing progression to SD. A survey was administered to providers assessing knowledge and comfort post-implementation. Results: There has been high usability with 58% (18/31) of providers surveyed having used the pathway at least once. Provider comfort has improved, with 89% (25/28) of respondents reporting increased comfort managing SD due to the clarity of the pathway and stepwise directions. Conclusions: The pathway fills a gap in the in-hospital management of dystonia and has led to increased provider comfort.