Status epilepticus alert reduces time to administration of second-line antiseizure medications

Mauricio F. Villamar; Aaron M. Cook; Chenlu Ke; Yan Xu; Jordan L. Clay; Katelyn S. Dolbec; Rachel Ward-Mitchell; Larry B. Goldstein; Meriem Bensalem-Owen

doi:10.1212/CPJ.0000000000000544

Status epilepticus alert reduces time to administration of second-line antiseizure medications

Mauricio F. Villamar, Aaron M. Cook, Chenlu Ke, Yan Xu, Jordan L. Clay, Katelyn S. Dolbec, Rachel Ward-Mitchell, Larry B. Goldstein, Meriem Bensalem-Owen

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Background Status epilepticus (SE) is a neurologic emergency with high morbidity and mortality. Delays in SE treatment are common in clinical practice and can be associated with poorer outcomes. Our goal was to determine whether the implementation of an SE alert protocol improves time to administration of a second-line antiseizure medication (ASM) in hospitalized adults. Methods We developed and implemented an inpatient SE alert system. A quasiexperimental cohort study was performed. We analyzed all patients aged 18-85 years who were managed at the University of Kentucky Medical Center using the SE alert protocol between March 2015 and June 2017 (n = 19). Controls were the first 20 consecutive patients treated for SE over the same time period, but who were managed with usual care (i.e., without SE alert protocol). Results Time to administration of a second-line ASM was shorter with the use of the SE alert system (22.21 ± 3.44 minutes) compared to usual care (58.30 ± 6.72 minutes; p < 0.0001). Conclusion Implementation of an SE alert system led to a marked improvement in time to administration of a second-line ASM. Classification of evidence This study provides Class III evidence that for adult inpatients treated for SE, implementation of an SE alert protocol reduces time to administration of second-line ASM.

Original language	English
Pages (from-to)	486-491
Number of pages	6
Journal	Neurology: Clinical Practice
Volume	8
Issue number	6
DOIs	https://doi.org/10.1212/CPJ.0000000000000544
State	Published - Dec 1 2018

Bibliographical note

Funding Information:
M.F. Villamar has received research support from an Alpha Omega Alpha Postgraduate Award, a seed grant from EpiC, the University of Kentucky Epilepsy Research Center, and from an American Academy of Neurology Safety and Quality Award. A.M. Cook, C. Ke, Y. Xu, J.L. Clay, K.S. Dolbec, and R. Ward-Mitchell report no disclosures. L.B. Goldstein serves on scientific advisory boards for Roche, Shin Poong, Shire, and Nestlé; serves as Associate Editor for Cerebrovascular Diseases and on the editorial boards of Emergency Medicine, Stroke, Neurology®, Journal of Stroke and Cerebrovascular Disease, and Cardiology Today; is author on a patent re: Test for amylin deposition; receives publishing royalties from UpToDate and from Henry Stewart Talks; serves as a consultant for Shin Poong and Nestlé; and receives research support from Nestlé, NIH, and American Heart Association. M. Bensalem Owen serves as Associate Editor for BMC Neurology; receives research support from NeuroPace, GW Pharmaceutical, and Sunovion; and serves on the Board of Directors of the National Association of Epilepsy Centers and the Board of Directors of the Epilepsy Foundation of Kentuckiana. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

Publisher Copyright:
Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

ASJC Scopus subject areas

Clinical Neurology

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10.1212/CPJ.0000000000000544

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@article{7184f9eef35749bdae722cc3560106e4,

title = "Status epilepticus alert reduces time to administration of second-line antiseizure medications",

abstract = "Background Status epilepticus (SE) is a neurologic emergency with high morbidity and mortality. Delays in SE treatment are common in clinical practice and can be associated with poorer outcomes. Our goal was to determine whether the implementation of an SE alert protocol improves time to administration of a second-line antiseizure medication (ASM) in hospitalized adults. Methods We developed and implemented an inpatient SE alert system. A quasiexperimental cohort study was performed. We analyzed all patients aged 18-85 years who were managed at the University of Kentucky Medical Center using the SE alert protocol between March 2015 and June 2017 (n = 19). Controls were the first 20 consecutive patients treated for SE over the same time period, but who were managed with usual care (i.e., without SE alert protocol). Results Time to administration of a second-line ASM was shorter with the use of the SE alert system (22.21 ± 3.44 minutes) compared to usual care (58.30 ± 6.72 minutes; p < 0.0001). Conclusion Implementation of an SE alert system led to a marked improvement in time to administration of a second-line ASM. Classification of evidence This study provides Class III evidence that for adult inpatients treated for SE, implementation of an SE alert protocol reduces time to administration of second-line ASM.",

author = "Villamar, {Mauricio F.} and Cook, {Aaron M.} and Chenlu Ke and Yan Xu and Clay, {Jordan L.} and Dolbec, {Katelyn S.} and Rachel Ward-Mitchell and Goldstein, {Larry B.} and Meriem Bensalem-Owen",

note = "Funding Information: M.F. Villamar has received research support from an Alpha Omega Alpha Postgraduate Award, a seed grant from EpiC, the University of Kentucky Epilepsy Research Center, and from an American Academy of Neurology Safety and Quality Award. A.M. Cook, C. Ke, Y. Xu, J.L. Clay, K.S. Dolbec, and R. Ward-Mitchell report no disclosures. L.B. Goldstein serves on scientific advisory boards for Roche, Shin Poong, Shire, and Nestl{\'e}; serves as Associate Editor for Cerebrovascular Diseases and on the editorial boards of Emergency Medicine, Stroke, Neurology{\textregistered}, Journal of Stroke and Cerebrovascular Disease, and Cardiology Today; is author on a patent re: Test for amylin deposition; receives publishing royalties from UpToDate and from Henry Stewart Talks; serves as a consultant for Shin Poong and Nestl{\'e}; and receives research support from Nestl{\'e}, NIH, and American Heart Association. M. Bensalem Owen serves as Associate Editor for BMC Neurology; receives research support from NeuroPace, GW Pharmaceutical, and Sunovion; and serves on the Board of Directors of the National Association of Epilepsy Centers and the Board of Directors of the Epilepsy Foundation of Kentuckiana. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp. Publisher Copyright: Copyright {\textcopyright} 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.",

year = "2018",

month = dec,

day = "1",

doi = "10.1212/CPJ.0000000000000544",

language = "English",

volume = "8",

pages = "486--491",

number = "6",

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T1 - Status epilepticus alert reduces time to administration of second-line antiseizure medications

AU - Villamar, Mauricio F.

AU - Cook, Aaron M.

AU - Ke, Chenlu

AU - Xu, Yan

AU - Clay, Jordan L.

AU - Dolbec, Katelyn S.

AU - Ward-Mitchell, Rachel

AU - Goldstein, Larry B.

AU - Bensalem-Owen, Meriem

N1 - Funding Information: M.F. Villamar has received research support from an Alpha Omega Alpha Postgraduate Award, a seed grant from EpiC, the University of Kentucky Epilepsy Research Center, and from an American Academy of Neurology Safety and Quality Award. A.M. Cook, C. Ke, Y. Xu, J.L. Clay, K.S. Dolbec, and R. Ward-Mitchell report no disclosures. L.B. Goldstein serves on scientific advisory boards for Roche, Shin Poong, Shire, and Nestlé; serves as Associate Editor for Cerebrovascular Diseases and on the editorial boards of Emergency Medicine, Stroke, Neurology®, Journal of Stroke and Cerebrovascular Disease, and Cardiology Today; is author on a patent re: Test for amylin deposition; receives publishing royalties from UpToDate and from Henry Stewart Talks; serves as a consultant for Shin Poong and Nestlé; and receives research support from Nestlé, NIH, and American Heart Association. M. Bensalem Owen serves as Associate Editor for BMC Neurology; receives research support from NeuroPace, GW Pharmaceutical, and Sunovion; and serves on the Board of Directors of the National Association of Epilepsy Centers and the Board of Directors of the Epilepsy Foundation of Kentuckiana. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp. Publisher Copyright: Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background Status epilepticus (SE) is a neurologic emergency with high morbidity and mortality. Delays in SE treatment are common in clinical practice and can be associated with poorer outcomes. Our goal was to determine whether the implementation of an SE alert protocol improves time to administration of a second-line antiseizure medication (ASM) in hospitalized adults. Methods We developed and implemented an inpatient SE alert system. A quasiexperimental cohort study was performed. We analyzed all patients aged 18-85 years who were managed at the University of Kentucky Medical Center using the SE alert protocol between March 2015 and June 2017 (n = 19). Controls were the first 20 consecutive patients treated for SE over the same time period, but who were managed with usual care (i.e., without SE alert protocol). Results Time to administration of a second-line ASM was shorter with the use of the SE alert system (22.21 ± 3.44 minutes) compared to usual care (58.30 ± 6.72 minutes; p < 0.0001). Conclusion Implementation of an SE alert system led to a marked improvement in time to administration of a second-line ASM. Classification of evidence This study provides Class III evidence that for adult inpatients treated for SE, implementation of an SE alert protocol reduces time to administration of second-line ASM.

AB - Background Status epilepticus (SE) is a neurologic emergency with high morbidity and mortality. Delays in SE treatment are common in clinical practice and can be associated with poorer outcomes. Our goal was to determine whether the implementation of an SE alert protocol improves time to administration of a second-line antiseizure medication (ASM) in hospitalized adults. Methods We developed and implemented an inpatient SE alert system. A quasiexperimental cohort study was performed. We analyzed all patients aged 18-85 years who were managed at the University of Kentucky Medical Center using the SE alert protocol between March 2015 and June 2017 (n = 19). Controls were the first 20 consecutive patients treated for SE over the same time period, but who were managed with usual care (i.e., without SE alert protocol). Results Time to administration of a second-line ASM was shorter with the use of the SE alert system (22.21 ± 3.44 minutes) compared to usual care (58.30 ± 6.72 minutes; p < 0.0001). Conclusion Implementation of an SE alert system led to a marked improvement in time to administration of a second-line ASM. Classification of evidence This study provides Class III evidence that for adult inpatients treated for SE, implementation of an SE alert protocol reduces time to administration of second-line ASM.

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ER -

Status epilepticus alert reduces time to administration of second-line antiseizure medications

Abstract

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