ImprovingtheManagementofPaediatricProlongedSeizuresinWessex
NBhangu1,OShields2,KPryde3
1.CommunityPaediatrics,SolentNHSTrust,2.AnaestheIcs,UniversityHospitalSouthampton.3.Paediatrics,SouthamptonChildrens’Hospital
Background&AimsEvidencesuggests(1,2,3)highmorbidityandmortalityforchildrenwithprolongedseizures.A6monthretrospecIveauditatQueenAlexandraHospitalin2016supportedthisevidenceandprovidedthebasisforaregionalprojectwhichwaslaunchedinDecember2016.
Theaimistoimprovemorbidityandmortalityofchildrenwithprolongedseizures(definedasthosepresenIngwithaseizureof>5minutesduraIon)asmeasuredby:
1.TimetoseizureterminaIon
2.Percentageintubated,venIlatedoradmiZedtolevel3care.
Asecondaryaimistoreducethenumberswithevidenceofrespiratory,haemodynamicormetaboliccompromise
Resultstodate:Overthefirst9monthsoftheproject,134caseshavebeencapturedfrom8centres.IniIaldatacollecIonwasslowandstrategiestoimprovethisincludingrefinementofanelectronicform,localleadschampioningtheprojectandlocaltargetedstrategiessuchaspostersandpaperlistshavebeensuccessful.
RunchartshavebeenploZedforregionalandlocalresultslookingatseizureduraIonoverIme–theaimistoreducevariabilityandstandardisepracIce.21.6%ofpaIentstodaterequiredintubaIonandthemajorityofthesewereintubatedforlessthan12hours.
Improvements&FuturePlans:Thefirstimprovementisbeingimplemented-afocuson‘thinkingahead’tothenextstepofthetreatmentalgorithm.RegionallythisisplannedviatheSORTguideline.Locally,runchartshavebeenproducedandlocalcentresareconsideringhowtobestachievethisimprovement.
References:1.SahinM.,MenacheC.,HolmesG.,RivielloJ.OutcomeofSevereRefractoryStatusEpilepIcusinChildren.Epilepsia.2001.42,111461-1467.2.NeliganA,ShorvonSD.PrognosIcfactors,morbidityandmortalityintonic-clonicstatusepilepIcus:Areview.EpilepsyResearch.2011.93,11-10.3.FountainN.,StatusEpilepIcus:RiskFactorsandComplicaIons.Epilepsia.2000.41,2.523-530.
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Arrival to anticonvulsant load run chart
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Seizure duration over time
IniIalrunchartsplojng‘Imetophenytoin(orequivalentanIconvulsant)’havebeenmodifiedtoplot‘Imefromarrivaltophenytoin’akerfeedbackandobservaIonthatalagperiodbetweentheImeofseizurestarttoarrivalinhospitalwasaffecIngthe‘Imetophenytoin’results.
Inviewofthefeedbackandresultson‘Imetotransfer’andmedicaIonsadministeredprehospital,consideraIonhasbeengiventotargeIngprehospitalhealth-careworkerstoimprovetheirknowledgeandconfidenceinmanagingpaediatricseizures.Atpresent,thisisnoteasilyachievedandhasbeenpostponedunIlapaediatricSIMprogrammeforprehospitalstaffisestablished.
WearehopingtouIliseanurseoralliedhealthcareprofessionalviaPIERtofacilitateimplementaIonofimprovements.ForallintervenIons,thePDSAcycleswithconInuousmonitoringofoutcomeswillbeusedtotrackeffects.Wherelocalchangesleadtoimprovementinoutcomes,wewillusetheregionalnatureoftheprojecttoenableothercentrestolearnandbenefitfromthislearning.
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Acknowledgements:LesleyMalonyforhelpwiththePICU/SORTdatabase.EveryoneinvolvedindatacollecIonandtrustleadsateachsite:QueenAlexandra–AmandaFreeman,HelenPeet,MahbubaBegum,AlexandraSnell;Poole–DavidShortland,KateGoyder,JusInThuraisingham;Chichester–KatyWalker;RHCH–,EllieGlenday,RituBeri;RHCH–ReynellaMorenas,LucyEveriZ;UHS–KatePryde,JasonBarling,AliceLording,DarrenRanasinghe,NatashaTisoszky;Dorchester–PennyMancais;BNHH–JamesEdelman,FionaMcHugh,KateHerriots;Salisbury–JimBaird,AidanJoyce.
