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

Abstract

This study was designed to identify factors related to delays in pre-hospital management of status epilepticus (SE). This retrospective study includes all adult (>16years of age) patients (N=82) diagnosed with established SE in the Helsinki University Central Hospital emergency department (ED) over 2years. SE was defined as a clinically observed episode fulfilling one of the following criteria: (1) continuous seizure lasting over 30min; (2) recurring seizures without return of consciousness between seizures; (3) occurrence of more than four seizures within any 1h. 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. 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. 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.