Abstract
Respiratory infections following status epilepticus (SE) are frequent, and associated with higher mortality, prolonged ICU stay, and higher rates of refractory SE. Lack of airway protection may contribute to respiratory infectious complications. This study investigates the order and frequency of physicians treating a simulated SE following a systematic Airways-Breathing-Circulation-Disability-Exposure (ABCDE) approach, identifies risk factors for non-adherence, and analyzes the compliance of an ABCDE guided approach to SE with current guidelines. We conducted a prospective single-blinded high-fidelity trial at a Swiss academic simulator training center. Physicians of different affiliations were confronted with a simulated SE. Physicians (n = 74) recognized SE and performed a median of four of the five ABCDE checks (interquartile range 3–4). Thereof, 5% performed a complete assessment. Airways were checked within the recommended timeframe in 46%, breathing in 66%, circulation in 92%, and disability in 96%. Head-to-toe (exposure) examination was performed in 15%. Airways were protected in a timely manner in 14%, oxygen supplied in 69%, and antiseizure drugs (ASDs) administered in 99%. Participants’ neurologic affiliation was associated with performance of fewer checks (regression coefficient −0.49; p = 0.015). We conclude that adherence to the ABCDE approach in a simulated SE was infrequent, but, if followed, resulted in adherence to treatment steps and more frequent protection of airways.
Highlights
Participants were only aware of other peers participating during the same time slot, and were not informed about the identities of any other peers participating in the study
As we investigated adherence in subgroups according to different medical specialties, we aimed to include approximately 20 participants per subgroup
With the representation being consistent with the current percentage of males in medical education in Switzerland (BAG Statistiken Ärztinnen/Ärzte, 2019)
Summary
Patients in SE are at risk for systemic complications, including infections, massive catecholamine releases resulting in neurocardiogenic and pulmonary injury [1,2], and physical injuries due to convulsions or falls [3]. Current international SE treatment guidelines outline individual treatment steps [4,5,6], they are vague in their indication of sequence, weighting of recommended treatment steps, and lack a more systematic outline, such as the ABCDE approach. According to a systematic review, delayed administration, or wrong dosing of ASDs, seems to be frequent, and is reported in more than 60% of cases [7]. A recent randomized controlled trial has shown that intubation after established SE is independent of baseline characteristics and early neurologic recovery, though it is strongly associated with site-specific practice pattern variation [8]. A recent study showed high variability of SE treatment in EMS algorithms in the US [9]
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